Abstract
Background
Patients that have a hydrophilic intraocular lens (IOL) inserted during cataract surgery are more likely to develop posterior capsular opacification (PCO) and require YAG laser posterior capsulotomy than those with hydrophobic IOLs. This study aimed to examine the cost implications of hydrophilic and hydrophobic IOL usage in NHS-funded cataract services in England and estimate the cost saving of increased hydrophobic IOL usage.
Methods
The cost of IOLs and YAG laser posterior capsulotomy was determined using NHS Spend Comparison Service data and Payment by Results tariffs. Data from the National Ophthalmology Database (NOD) audit was used to estimate PCO rates and the proportion of cataract cases that used hydrophilic and hydrophobic IOLs in England during the 2022 NHS year.
Results
The cumulative cost per case of purchasing an IOL and YAG laser posterior capsulotomy treatment over the 9-year period following cataract surgery was £148.73 (£96.83–£199.12) for hydrophilic IOLs and £107.58 (£62.99–£150.05) for hydrophobic IOLs. Of the cataract cases performed in England during the 2022 NHS year that were reported to the NOD, 52% used hydrophilic IOLs and 46% used hydrophobic IOLs. If all cases that used hydrophilic IOLs in England during the 2022 NHS year had instead used hydrophobic IOLs, the reduced need for YAG laser posterior capsulotomies could have saved around £13.0 million (£10.7 million–£15.6 million).
Conclusions
Hydrophilic IOLs remain popular amongst NHS-funded cataract services in England. Increasing hydrophobic IOL usage could be an effective strategy for lowering PCO rates while generating recurrent annual financial savings.
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Data availability
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.
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Acknowledgements
We acknowledge with thanks the contribution of Professor John Sparrow who provided diligent clinical and academic oversight and leadership of the RCOphth NOD over many years to bring it to its current stature. 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 conscientious electronic data collection as they go about caring for their patients.
Funding
The RCOphth National Ophthalmology Database Cataract Audit is currently funded through participation fees from centres as well as unrestricted financial contributions from Alcon and Bausch and Lomb.
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All authors contributed to the study design and data collection. JM produced first draft and final manuscript. All authors offered comments and agreed the final manuscript.
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Malcolm, J., Donachie, P.H.J., Hernández, R. et al. The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 20, the hidden cost of intraocular lens choices for National Health Service funded cataract surgery in England. Eye (2025). https://doi.org/10.1038/s41433-025-04033-4
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DOI: https://doi.org/10.1038/s41433-025-04033-4
