Abstract
Objective
To determine whether socioeconomic status influenced the presenting visual acuity prior to first eye cataract surgery in the English National Health Service. Retrospective case series from The Royal College of Ophthalmologists’ National Ophthalmology Database Audit. In total 154,223 patients undergoing first eye cataract surgery at 68 centres in England performed between 1st September 2015 and 31st August 2017.
Main outcome measure
Social deprivation status and pre-operative visual acuity (VA) between centres for patients undergoing first eye cataract surgery in England.
Results
The median social deprivation varied between centres and ranged from decile 2 (2nd most deprived decile) to decile 9 (2nd least deprived decile). The pre-operative VA was reported for 143,401 (93.0%) eyes. The median pre-operative VA was 0.50 LogMAR (6/19), and 27.7% eyes had a preoperative VA of 0.30 LogMAR units (6/12) or better. The median pre-operative VA for each centre ranged from 0.30 to 0.60 LogMAR (6/12 to 6/24). The median pre-operative VA was mostly stable across deciles of social deprivation (0.60 LogMAR for decile 1 and 0.50 LogMAR for all other deciles), and some evidence was found linking greater deprivation to worse pre-operative VA and to lower levels of access.
Conclusions
We found no strong evidence of inequality for gaining access to first eye cataract surgery in this National Ophthalmology Database analysis, however there was a possible trend towards fewer people in the more deprived deciles accessing surgery, and that some of these are presenting with quite marked levels of visual impairment.
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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 the National Ophthalmology Database Audit and thank our medical and non-medical colleagues for the considerable time and effort devoted to data collection. The 68 participating centres included in this study are listed in alphabetic order below. Aintree University Hospital NHS Foundation Trust; Barking, Havering and Redbridge University Hospitals NHS Trust; Barts Health NHS Trust; Blackpool Teaching Hospitals NHS Foundation Trust; Bradford Teaching Hospitals NHS Foundation Trust; Calderdale and Huddersfield NHS Foundation Trust; Manchester University NHS Foundation Trust; Chesterfield Royal Hospital NHS Foundation Trust; County Durham and Darlington NHS Foundation Trust; East Lancashire Hospitals NHS 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; Mid Cheshire Hospitals NHS Foundation Trust; Moorfields Eye Centre at Bedford Hospital NHS Trust*; Moorfields Eye Centre at Croydon Health Services NHS Trust*; Nottingham University Hospitals NHS Trust; Norfolk and Norwich University Hospitals NHS Foundation Trust; North West Anglia NHS Foundation Trust; Northern Devon Healthcare NHS Trust; Oxford University Hospitals NHS Foundation Trust; Plymouth Hospitals NHS Trust; Portsmouth Hospitals 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; 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; The Hillingdon Hospitals NHS Foundation Trust; East Suffolk and North Essex NHS Foundation Trust; The Newcastle upon Tyne Hospitals NHS Foundation Trust; The Mid Yorkshire Hospitals NHS Trust; The Princess Alexandra Hospital NHS Trust; The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust; Torbay and South Devon NHS Foundation 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 of Morecambe Bay NHS Foundation 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; Plus the following SpaMedica centres providing NHS funded cataract surgery, Bolton; Liverpool; Manchester; Newton-le-Willows; Wakefield; Wirral; *These two centres data have been combined as they are part of the same governing authority for ophthalmology.
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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). All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: PHJD, RJ (deceased) and JMS had financial support from HQIP for the submitted work; RJ was previously a director of Medisoft, the provider of the EMR with which the majority of the data for this study were collected; no other financial relationships with organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. ACD was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the author(s) and not necessarily of the NHS, the NIHR, HQIP or the Department of Health.
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Johnston, R.L., Day, A.C., Donachie, P.H.J. et al. The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 4, equity of access to cataract surgery. Eye 34, 530–536 (2020). https://doi.org/10.1038/s41433-019-0524-x
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DOI: https://doi.org/10.1038/s41433-019-0524-x
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