To mark Eye Health Awareness Week (20-26 September) the Health and Social Care Board in conjunction with HSC Trusts and the Northern Ireland Eyecare Network is today issuing new recommendations on routine cataract care to help rapidly increase hospital capacity to see patients with urgent, complex or sight threatening disease.
Cataract is the single biggest scheduled (elective) procedure in Northern Ireland with over 10,000 carried out each year. Before the COVID-19 pandemic, cataracts were carried out in busy ophthalmology outpatient clinics in acute hospital settings.
The combination of pre-existing capacity constraints and the effect of the COVID-19 pandemic has led to record numbers of patients, whose ophthalmology outpatient appointments and surgery are delayed, putting large numbers of patients at real risk of avoidable sight loss.
One potential solution is to manage certain groups of low-risk patients outside of traditional hospital-based pathways, where this can be delivered without compromising safety and quality of care.
From October 2021, suitable patients who have undergone cataract procedures will be offered their post-operative review with a community optometrist, closer to home, rather than at the acute hospital setting.
The community optometrist will carry out the same assessment and review checks as the hospital teams, and feedback clinical outcome and experience measures to the operating surgical team.
The Royal College of Ophthalmologists and the College of Optometrists have welcomed the recommendations on routine cataract care.
“Hospital eye departments have never been busier” said Julie Silvestri, Clinical Director for Ophthalmology for Belfast HSC Trust and Clinical Lead for the NI Eyecare Network.
“This scheme helps to relieve pressure, ensuring that only those patients who need to go to hospital for their care do so. We see the community optometrist as an excellent resource to help manage demand and work closely with the hospital teams.”
Patients who have had routine, uncomplicated cataract surgery will be discharged from the hospital cataract service and offered their post-operative review with a local optometrist.
Post-operative care plans will be clearly communicated to patients at the initial appointment. Patients will have a clear route for advice and assessment for unexpected issues and emergencies such as endophthalmitis (inflammation of the tissues inside the eye).
Raymond Curran, Head of Ophthalmic Services at the HSC Board said; “The post-operative cataract review and assessment scheme is a further example of how the knowledge, skills and accessibility of High Street Optometrists can be employed to redesign and integrate services so that patients are managed and treated at the right time, by the right person in the right place, making a positive impact on waiting lists and patient experience.”
This initiative will free much-needed capacity in ophthalmology departments, helping to close demand-capacity gaps, and managing patients closer to home. It is envisaged that the majority of the 10K cataract reviews will be undertaken in the community as soon as possible.
“Community optometrists are well-placed to take on extended care roles such as this post-operative scheme,” said William Stockdale, Chair of Optometry, NI.
He added, “We are accessible, already have a relationship with the patient and with the electronic loop. This will be a key partner in improving patient outcomes across primary and secondary care.”
The optometrist will examine the patient’s eyes following surgery. They will also carry out the eye test and adjust any prescriptions where necessary. On normal cases, glasses can be updated at this stage where needed.
The scheme is in line with the Health Minister’s Elective Care Framework complementing commitments to pre-assessment mega-clinics and cataract day procedure centre.
Health Minister Robin Swann said: “Any HSC initiative to build system capacity and free much-needed secondary care resource whilst managing demand closer to home is to be welcomed.
“The skills, equipment and accessibility of community optometrists can now be used to provide, in time, the majority of post-operative cataract care. IT and communications channels are in place to report back on outcomes and patient experience, further integrating care and whole-system working, and ensuring that patients access care at the most appropriate point.
“This scheme complements work which my Department is taking forward to improve access and reduce waiting lists by the use of a regional network of dedicated cataract day procedure centres and the recently-commissioned mega-clinics for pre-operative cataract assessments.”