National Ophthalmology Database Audit Annual Report finds significantly better outcomes for cataract surgery patients

15 September 2020

The RCOphth has released its annual report for the National Ophthalmology Database (NOD) Audit 2018-2019. Since its inception, the NOD audit has been assuring high quality cataract surgical services for patients. The annual report finds a 40% overall reduction in the posterior capsule rupture (PCR) complication rates and a continuing decline in the number of surgeries affected by loss of visual acuity since 2010.

With approximately 452,000 cataract operations undertaken in England and 20,000 undertaken in Wales in 2018-19, the NOD enables contributing cataract surgeons to compare their performance against that of their peers nationally, ensuring a continued improvement in surgical outcomes and learning. It is a vital safeguard of patient safety and a promoter of best practice, potentially eliminating unwarranted variation in the provision of cataract surgery and patient care.

The fourth prospective national annual report continues to indicate clearly that high quality surgery is being delivered to NHS patients:

Key Findings

A 40% overall reduction in PCR complications since 2010
In the 2018-19 reporting period 1.14% of operations were affected by PCR, compared to 1.91% in 2010-11
A 44% overall reduction in VA Loss since 2010
In the 2018-19 reporting period 0.51% of operations were affected by VA loss, compared to 0.91% in 2010-11
Reduction in PCR complications and VA loss since 2010 equates to ~3,500 fewer complications annually across the NHS
Cost saving from avoided PCR complications ~£2 million per annum
100% data completeness for PCR outcomes, currently a compulsory field in Electronic Patient Records

In order to ensure these improvements continue to be met, the report also lists recommendations for patients, cataract surgery providers, commissioners and regulators, as well as providing a concrete set of next steps to ensure NODs remit expands, including further development of patient reported outcomes for cataract surgery to ensure that patient views of their vision are considered.

Next steps

In 2021, the fifth prospective audit period will move to align with the NHS year (April to March). This will aid centres with the planning of services and align the national cataract audit to other reporting services that report on the NHS year.
Electronic data collection for cataract surgery is being implemented in Northern Ireland who wish to participate as a region in future audit years.
The RCOphth NOD is committed to further developing the collection of the existing patient reported outcome measure (PROM) for cataract surgery, with the aim of implementing this in the national cataract audit.
Initial steps have been taken towards establishing a national audit in wet age-related macular degeneration and it is anticipated that this will commence within the next two years.

Speaking on the report findings, RCOphth President Bernie Chang praised the findings, but called for greater participation in NOD by trusts and private providers to ensure continued improvements in cataract surgery and patient choice, stating, “Professor John Sparrow, lead clinician, and the NOD team have continued to develop the NOD as a world-leading audit. The findings once again highlight how the collection of data is so important to continuing to deliver high quality surgery and reduce the burden of complications on patients and the NHS, improving both patient choice and outcomes significantly. The prospect of what a future age related macular degeneration national audit will do for the medical retina sub-specialty patients is very exciting.’

The Royal College of Ophthalmologists is working with the NHS, trusts, providers and industry to find sustainable ways to fund both audits. Continued data collection through audits like the National Ophthalmology Database Audit, has a significant positive impact on patient care quality, human resources and NHS finances. Based on the NOD findings, we estimate a financial saving of £2million for the NHS per year by avoiding complications and associated costs of postoperative visits and further treatment.

You can read the full report here

You can also read the key findings here