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The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 16, influence of remuneration model on choice of intraocular lens in the UK

Eye volume 37, pages 3854–3860 (2023)Cite this article

Subjects

Abstract

Background/Objectives

Cataract surgery with intraocular lens (IOL) implantation is one of the most commonly performed surgeries worldwide. Within the UK, publicly funded cataract surgery is remunerated by two models: (1) “block contract” (BC), which commissions organisations to deliver whole service pathways without considering specific activity items; or (2) “payment by results” (PbR), which pays a tariff price for each procedure. This study aimed to examine the association between remuneration model and the cost and types of IOL used.

Subjects/Methods

Cataract operations recorded on the Royal College of Ophthalmologists’ National Ophthalmology Database were included, with additional data collected for remuneration model from NHS England and cost of IOL from the NHS Spend Comparison Service.

Results

We included 907,052 cataract operations from 87 centres. The majority of operations were performed in PbR centres (456 198, 50.3%), followed by BC centres (240 641, 26.5%) and mixed models centres (210 213, 23.2%). The mean price of hydrophobic (n = 7) and hydrophilic IOLs (n = 5) were £45.72 and £42.86, respectively. Hydrophobic IOLs were predominantly used (650 633, 71.7%) and were significantly more commonly used in centres remunerated by BC (96.5% vs. 3.5%) than those by PbR (65.7% vs. 34.3%) when compared to hydrophilic IOLs (p < 0.001).

Conclusions

This study demonstrated that the IOL choice may be perversely incentivised by the IOL cost and remuneration model. Although hydrophobic IOLs are more expensive at the point of surgery, their potential longer-term cost-effectiveness due to reduced requirement for YAG capsulotomy should be considered.

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Fig. 1: IOL model usage broken down by remuneration method.

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Data availability

The NHS England Spend Comparison Service (SCS) data utilised for this study is available to appropriate NHS bodies to the SCS by application, but cannot be made publicly available by those accessing it for secondary purposes. Access to the data from Royal College of Ophthalmologists’ National Ophthalmology Database cataract audit can be accessed by application from appropriate academic or clinical organisations to noa.project@rcophth.ac.uk, however, preparation of the data would require a fee to cover full costs of extracting and preparing the necessary data for the intended purpose from the National Ophthalmology Database.

References

  1. Cicinelli MV, Buchan JC, Nicholson M, Varadaraj V, Khanna RC. Cataracts. Lancet. 2023;401:377–89.

    Article  PubMed  Google Scholar 

  2. Ting DSJ, Deshmukh R, Ting DSW, Ang M. Big data in corneal diseases and cataract: current applications and future directions. Front Big Data. 2023;6:1017420.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chen X, Xu J, Chen X, Yao K. Cataract: advances in surgery and whether surgery remains the only treatment in future. Adv Ophthalmol Pract Res. 2021;1:100008.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lamoureux EL, Fenwick E, Pesudovs K, Tan D. The impact of cataract surgery on quality of life. Curr Opin Ophthalmol. 2011;22:19–27.

    Article  PubMed  Google Scholar 

  5. Muralikrishnan R, Venkatesh R, Prajna NV, Frick KD. Economic cost of cataract surgery procedures in an established eye care centre in Southern India. Ophthalmic Epidemiol. 2004;11:369–80.

    Article  CAS  PubMed  Google Scholar 

  6. Srinivasan S, Ting DS, Lyall DA. Implantation of a customized toric intraocular lens for correction of post-keratoplasty astigmatism. Eye. 2013;27:531–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Erie JC. Rising cataract surgery rates: demand and supply. Ophthalmology. 2014;121:2–4.

    Article  PubMed  Google Scholar 

  8. Salerno LC, Tiveron MC Jr, Alió JL. Multifocal intraocular lenses: types, outcomes, complications and how to solve them. Taiwan J Ophthalmol. 2017;7:179–84.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ting DSJ, Rees J, Ng JY, Allen D, Steel DHW. Effect of high-vacuum setting on phacoemulsification efficiency. J Cataract Refract Surg. 2017;43:1135–9.

    Article  PubMed  Google Scholar 

  10. Day AC, Burr JM, Bennett K, Bunce C, Doré CJ, Rubin GS, et al. Femtosecond laser-assisted cataract surgery versus phacoemulsification cataract surgery (FACT): a randomized noninferiority trial. Ophthalmology. 2020;127:1012–9.

    Article  PubMed  Google Scholar 

  11. Luo C, Wang H, Chen X, Xu J, Yin H, Yao K. Recent advances of intraocular lens materials and surface modification in cataract surgery. Front Bioeng Biotechnol. 2022;10:913383.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Donachie PHJ, Barnes BL, Olaitan M, Sparrow JM, Buchan JC. The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: Report 9, Risk factors for posterior capsule opacification. Eye. 2023;37:1633–9.

  13. Zhao Y, Yang K, Li J, Huang Y, Zhu S. Comparison of hydrophobic and hydrophilic intraocular lens in preventing posterior capsule opacification after cataract surgery: an updated meta-analysis. Medicine. 2017;96:e8301.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Dixon J. Payment by results-new financial flows in the NHS. BMJ. 2004;328:969–70.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Berdahl J, Bala C, Dhariwal M, Rathi H, Gupta R. Cost-benefit analysis of a trifocal intraocular lens versus a monofocal intraocular lens from the patient’s perspective in the United States. PLoS ONE. 2022;17:e0277093.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Nanavaty MA, Spalton DJ, Boyce J, Brain A, Marshall J. Edge profile of commercially available square-edged intraocular lenses. J Cataract Refract Surg. 2008;34:677–86.

    Article  PubMed  Google Scholar 

  17. Nanavaty MA, Zukaite I, Salvage J. Edge profile of commercially available square-edged intraocular lenses: Part 2. J Cataract Refract Surg. 2019;45:847–53.

    Article  PubMed  Google Scholar 

  18. Ursell PG, Dhariwal M, Majirska K, Ender F, Kalson-Ray S, Venerus A, et al. Three-year incidence of Nd:YAG capsulotomy and posterior capsule opacification and its relationship to monofocal acrylic IOL biomaterial: a UK Real World Evidence study. Eye. 2018;32:1579–89.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ursell PG, Dhariwal M, O'Boyle D, Khan J, Venerus A. 5 year incidence of YAG capsulotomy and PCO after cataract surgery with single-piece monofocal intraocular lenses: a real-world evidence study of 20,763 eyes. Eye. 2020;34:960–8.

    Article  CAS  PubMed  Google Scholar 

  20. Giers BC, Tandogan T, Auffarth GU, Choi CY, Auerbach FN, Sel S, et al. Hydrophilic intraocular lens opacification after posterior lamellar keratoplasty - a material analysis with special reference to optical quality assessment. BMC Ophthalmol. 2017;17:150.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ng JY, Ting DSJ, Thomas S, Auffarth GU, Merz P. Opacification of hydrophilic acrylic intraocular lens following vitreoretinal surgery: a clinicopathological report. Can J Ophthalmol. 2021;56:e9–e11.

    Article  PubMed  Google Scholar 

  22. Grzybowski A, Zemaitiene R, Markeviciute A, Tuuminen R. Should we abandon hydrophilic intraocular lenses? Am J Ophthalmol. 2022;237:139–45.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

It is with gratitude that we remember 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 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 87 centres with data in this analysis are listed in alphabetical order below separated into NHS Trusts and ISTC sites.

NHS Trusts:

Barking, Havering and Redbridge University Hospitals NHS Trust; Barts Health NHS Trust; Bolton NHS Foundation Trust; Bradford Teaching Hospitals NHS Foundation 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; Liverpool University Hospitals NHS Foundation Trust; Manchester University NHS Foundation Trust; Mid Cheshire Hospitals NHS Foundation Trust; Mid and South Essex NHS Foundation Trust; Moorfields Eye Hospital NHS Foundation Trust*; Norfolk and Norwich University Hospitals NHS Foundation Trust; North Cumbria Integrated Care NHS Foundation Trust; North Middlesex University Hospital NHS Trust; North West Anglia NHS Foundation Trust; Nottingham University Hospitals NHS Trust; Oxford University Hospitals NHS Foundation Trust; Portsmouth Hospitals University NHS Trust; Royal Berkshire NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust; Royal Free London 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; South Tees Hospitals NHS Foundation Trust; South Warwickshire University NHS Foundation Trust; Southport and Ormskirk Hospital NHS Trust; St Helens and Knowsley Teaching Hospitals NHS Trust; Surrey and Sussex Healthcare NHS Trust; The Hillingdon Hospitals NHS Foundation Trust; The Mid Yorkshire Hospitals NHS Trust; The Newcastle upon Tyne Hospitals NHS Foundation Trust; The Princess Alexandra Hospital NHS Trust; The Shrewsbury and Telford Hospital NHS Trust; Torbay and South Devon NHS Foundation Trust; United Lincolnshire Hospitals NHS Trust; University Hospital Southampton NHS Foundation Trust; University Hospitals Birmingham NHS Foundation Trust; University Hospitals Bristol and Weston NHS Foundation Trust; University Hospitals Coventry and Warwickshire NHS Trust; University Hospitals Dorset NHS Foundation Trust; University Hospitals Plymouth NHS Trust; Warrington and Halton Teaching Hospitals NHS Foundation Trust; Wirral University Teaching Hospital NHS Foundation Trust; Yeovil District Hospital NHS Foundation Trust;

ISTC sites:

St. Stephens Gate Medical Practice;

The following sites from Optegra Eye Health Care: Birmingham Eye Hospital; Central London Eye Hospital; Hampshire Eye Hospital; Manchester Eye Hospital; North London Eye Hospital; Surrey Eye Hospital; Yorkshire Eye Hospital;

The following sites from Practice Plus Group: Emersons Green; Ilford; Plymouth; Shepton Mallet; Southampton; Rochdale; Devizes; Gillingham; St. Mary’s Portsmouth

The following sites from SpaMedica: Birkenhead; Bolton; Liverpool; Manchester; Newton-le-Willows; Sheffield; Wakefield;

*Includes data from Bedford Hospital within Bedfordshire Hospitals NHS Foundation Trust and Croydon Health Services NHS Trust as the ophthalmology services in these places are part of Moorfields Eye Hospital NHS Foundation Trust.

Funding

This analysis was funded by an unconditional grant from Alcon (Geneva, Switzerland) in support of the Royal College of Ophthalmologists’ National Ophthalmology Database cataract audit. The funders did not have any editorial oversight, right of veto or academic input into the analysis or write up of this work. The National Cataract Audit is currently funded through participation fees from centres as well as unrestricted financial contributions from Bausch + Lomb and Alcon.

Author information

Authors and Affiliations

  1. Birmingham and Midland Eye Centre, Birmingham, UK

    Darren S. J. Ting

  2. Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK

    Darren S. J. Ting

  3. Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK

    Darren S. J. Ting

  4. Princess Alexandra Eye Pavilion, Edinburgh, UK

    Andrew J. Tatham

  5. Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK

    Andrew J. Tatham

  6. Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK

    Paul H. J. Donachie

  7. The Royal College of Ophthalmologists’ National Ophthalmology Audit, London, UK

    Paul H. J. Donachie & John C. Buchan

  8. International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK

    John C. Buchan

  9. Leeds Teaching Hospitals NHS Trust, Leeds, UK

    John C. Buchan

Authors
  1. Darren S. J. Ting
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  2. Andrew J. Tatham
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  3. Paul H. J. Donachie
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  4. John C. Buchan
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Contributions

All authors participated in initial discussions regarding study design and definitions. All authors reviewed initial drafts and approved final manuscript. DSJT and PHJD prepared the first draft (PHJD – “Methods” and “Results”; DSJT – “Introduction” and “Discussion”).

Corresponding author

Correspondence to John C. Buchan.

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Ting, D.S.J., Tatham, A.J., Donachie, P.H.J. et al. The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 16, influence of remuneration model on choice of intraocular lens in the UK. Eye 37, 3854–3860 (2023). https://doi.org/10.1038/s41433-023-02665-y

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