Cataract surgery is the most frequently undertaken NHS surgical procedure with approximately 390,000 cataract operations undertaken in England and 16,000 in Wales during 2015 - 2016.
The data presented on this page were collected from 56 NHS cataract surgical centres between 01 September 2015 to 31 August 2016 in England and Wales. Results are available for contributing NHS Trusts and for individual consultant surgeons. Please note that we have only published the outcomes for surgeons who have performed a minimum of 50 operations during the audit period.
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The cataract audit examined two prmiary indicators of surgical quality, Posterior Capsular Rupture (PCR) and Visual Acuity (VA) loss.
Posterior Capsular Rupture (PCR) is a break in the posterior capsule of the lens, and can be a complication of cataract surgery. It allows vitreous (A transparent substance with the consistency of egg-white which occupies the space inside the eye behind the lens) to move forward into the anterior chamber of the eye. PCR is the most powerful, and only potentially modifiable, predictor of visual harm from surgery and is widely accepted by surgeons as a marker of surgical skill (safety & effectiveness).
Please note that PCR is a situation that can occur during surgery and be corrected during the same surgery. Patients can have good surgical outcomes if the complication is corrected.
Patient characteristics and surgeon experience can influence the likelihood of PCR occurring and information collected pre-operatively can help to mitigate against these characteristics along with suitable surgeon allocation for each patient.
Visual Acuity (VA) Loss (visual harm from surgery): the most important outcome for cataract surgery is vision, this is what matters most to patients. Vision which is worse after the operation than before is identified as an adverse outcome.
Please note that the VA data recording is currently not complete at participating trusts. This has been recognised as a risk for the audit from the outset and despite significant efforts to improve this, including electronic data return tools for optometrists to use, this remains an issue.
Data completeness varies widely by centre depending on the local patient pathway for post-op care. Surgeons with less than or exactly 40% of both pre- and post-op VA data has been excluded from this outcome with a note to indicate that data completeness is inadequate for reporting.
Trust electronic medical record (EMR) systems: e.g. Medisoft, OpenEyes and in-house databases compliant with the RCOphth national cataract dataset. For both EMR sources the data used for the audit comprise the actual (anonymised) hospital record for each of the patients.
The data used in the audit analysis does not fully represent the total number of cataract surgery that is being performed every year in England and Wales. Some centres and surgeons have joined the audit towards the end of the data collection period and have contributed lesser cases to audit.