Background: Cataract extraction is the most frequently performed surgical intervention in the world and demand is rising due to an ageing demography. One option to address this challenge is to offer selected patients immediate sequential bilateral cataract surgery (ISBCS). This study aims to investigate patient and operative characteristics for ISBCS and delayed bilateral cataract surgery (DSCS) in the UK. Methods: Data were analysed from the Royal College of Ophthalmologists’ National Ophthalmology Database Audit (NOD) of cataract surgery. Eligible patients were those undergoing bilateral cataract extraction from centres with a record of at least one ISBCS operation between 01/04/2010 and 31/08/2018. Variable frequency comparison was undertaken with chi-square tests. Results: During the study period, 1073 patients had ISBCS and 248,341 DSCS from 73 centres. A higher proportion of ISBCS patients were unable to lie flat (11.3% vs. 1.8%; p ' 0.001), unable to cooperate (9.7% vs. 2.7%; p ' 0.001); underwent general anaesthesia (58.7% vs. 6.6% (p ' 0.001)); had brunescent/white/mature cataracts (odds ratio (OR) 5.118); no fundal view/vitreous opacities (OR 8.381); had worse pre-operative acuity 0.60 LogMAR ISBCS vs. 0.50 (first) and 0.40 (second eye) DSCS and were younger (mean ages, 71.5 vs. 75.6 years; p ' 0.001). Posterior capsular rupture (PCR) rates adjusted for case complexity were comparable (0.98% ISBCS and 0.78% DSCS). Conclusions: ISBCS was performed on younger patients, with difficulty cooperating and lying flat, worse pre-operative vision, higher rates of known PCR risk factors and more frequent use of general anaesthesia than DSCS in centres recorded on NOD.
Bibliographical noteFunding Information:
Acknowledgements It is with deep regret that we note the death of our friend and colleague Robert Johnston, who sadly died in September 2016. Without his inspirational vision, determination and career long commitment to quality improvement in ophthalmology this work would not have been possible. We would like to acknowledge the support and guidance we have received from the National Audit Steering Committee which includes professional members, ophthalmologists and optometrists, and patient and public representatives with individual lay members as well as patient support groups being represented. We acknowledge the support of the hospitals that participated in this National Ophthalmology Database Audit study and thank our medical and non-medical colleagues for the considerable time and effort devoted to data collection. The participating centres included in this study are listed in alphabetic order below, separated into the 68 NHS Trusts or Health Boards from England and Cymru respectively, and the 5 Independent sector treatment centres including one from the Channel Islands. NHS Trusts in England: Barking, Havering and Redbridge University Hospitals NHS Trust; Barts Health NHS Trust; Blackpool Teaching Hospitals NHS Foundation Trust; Bradford Teaching Hospitals NHS Foundation Trust; Brighton and Sussex University Hospitals NHS Trust; Calderdale and Huddersfield NHS Foundation Trust; Chesterfield Royal Hospital NHS Foundation Trust; County Durham and Darlington NHS Foundation Trust; East Kent Hospitals University NHS Foundation Trust; East Suffolk and North Essex NHS Foundation Trust; East Sussex Healthcare NHS Trust; Epsom and St Helier University Hospitals NHS Trust; Frimley Health NHS Foundation Trust; Gloucestershire Hospitals NHS Foundation Trust; Great Western Hospitals NHS Foundation Trust; Hampshire Hospitals NHS Foundation Trust; Harrogate and District NHS Foundation Trust; Imperial College Healthcare NHS Trust; Isle of Wight NHS Trust; James Paget University Hospitals NHS Foundation Trust; King's College Hospital NHS Foundation Trust; Kingston Hospital NHS Foundation Trust; Leeds Teaching Hospitals NHS Trust; London North West University Healthcare NHS Trust; Manchester University NHS Foundation Trust; Mid Cheshire Hospitals NHS Foundation Trust; Moorfields Eye Hospital NHS Foundation Trust*; Norfolk and Norwich University Hospitals NHS Foundation Trust; North Cumbria University Hospitals NHS Trust; North West Anglia NHS Foundation Trust; Northern Devon Healthcare NHS Trust; Nottingham University Hospitals NHS Trust; Oxford University Hospitals NHS Foundation Trust; Portsmouth Hospitals NHS Trust; Royal Berkshire NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust; Royal Free London NHS Foundation Trust; Royal Surrey County Hospital NHS Foundation Trust; Royal United Hospitals Bath NHS Foundation Trust; Salisbury NHS Foundation Trust; Sandwell and West Birmingham Hospitals NHS Trust; Sheffield Teaching Hospitals NHS Foundation Trust; Sherwood Forest Hospitals NHS Foundation Trust; Shrewsbury and Telford Hospital NHS Trust; South Tees Hospitals NHS Foundation Trust; South Warwickshire NHS Foundation Trust; Southport and Ormskirk Hospital NHS Trust; St Helens and Knowsley Teaching Hospitals NHS Trust; Stockport NHS Foundation Trust; Surrey and Sussex Healthcare NHS Trust; The Hillingdon Hospitals NHS Foundation Trust; The Newcastle upon Tyne Hospitals NHS Foundation Trust; The Rotherham NHS Foundation Trust; The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust; United Lincolnshire Hospitals NHS Trust; University Hospital Southampton NHS Foundation Trust; University Hospitals Birmingham NHS Foundation Trust; University Hospitals Bristol NHS Foundation Trust; University Hospitals Coventry and Warwickshire NHS Trust; University Hospitals Plymouth NHS Trust; Warrington and Halton Hospitals NHS Foundation Trust; Wirral University Teaching Hospital NHS Foundation Trust; Wrightington, Wigan and Leigh NHS Foundation Trust; Wye Valley NHS Trust; Yeovil District Hospital NHS Foundation Trust; York Teaching Hospital NHS Foundation Trust University health boards in Cymru: Cardiff and Vale University LHB Independent sector treatment centres: Care UK (Emersons Green NHS Treatment Centre); Care UK (North East London NHS Treatment Centre); Care UK (Southampton NHS Treatment Centre); Medical specialists group Guernsey; SpaMedica (Manchester); SpaMedica (Newton-le-Willows) *Including Bedford Hospital NHS Trust and Croydon Health Services NHS Trust as these are part of the same governing authority for ophthalmology.
Funding This study was supported through The Healthcare Quality Improvement Partnership (HQIP) commissioned Royal College of Ophthalmologists (RCOphth) National Ophthalmology Database Audit, which is part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) and the Clinical Outcomes Programme (COP). The salary of JC Buchan is supported by the Queen Elizabeth Diamond Jubilee Trust through the Commonwealth Eye Health Consortium.
© 2020, The Author(s), under exclusive licence to The Royal College of Ophthalmologists.