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First Author: E.Casswell UK
Co Author(s): N. Brennan M. Treacy F. Harman
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Toric intraocular lenses (IOLs) can improve visual outcomes for patients with significant astigmatism (>2 Dioptres). This benefit is countered by; increased cost & administrative time, cancellations due to delay in IOL delivery and additional time in the peri-operative management of patients. The use of an in-house bank of toric lenses aims to reduce some of these shortcomings. With this in mind, we introduced a bank of toric IOLs with a range covering 90% of the case load. The aim of this study was to evaluate the administrative and financial impact of using a bank of toric IOLs at a district general hospital.
Ophthalmology department in district general hospital
Retrospective analysis of all cataract surgery performed 6 months prior to, and 6 months after the introduction of a bank of toric IOLs (range of 16-23 dioptres of sphere and 2-6 dioptres of cylinder). In addition, all staff involved in the pre-operative assessment and ordering process of toric lenses were interviewed.
Over a twelve month period 1552 cataract operations were performed, of which 85 used toric IOLs: (Pre-bank: 48, post bank: 37). 6 months prior to the toric bank, 61 toric IOLs were ordered but only 48 of these were actually inserted, leaving 13 unused lens. The reasons for this included: intraoperative complications; pre-operative decision by surgeon, patient declined, ordering error, patient deceased before surgical date. 6 months after the introduction of the toric bank, 37 torics IOLs were inserted, of which 12 had to be ordered. These were for patients whose refractive needs lay outside the range of the bank. In total 2 IOLs were unused. This equates to an 85% reduction in number of ordered IOLs and 80% reduction in unused IOLs following introduction of the toric bank. This represents a saving of £2640 per year. Prior to the introduction of the bank, a 12 step process was required from pre-operative assessment to delivery of the lens to theatre. This was reduced to 6 steps with the bank in place, reducing administrative time by 50%. There was no significant difference in time from patients pre-operative assessment to their operation after introduction of the toric bank (46 vs 43.7 days)
Introduction of a bank of toric intraocular lenses, led to an 85% reduction in number of ordered IOLs and 80% reduction in unused IOLs. This resulted in an approximate saving of £2640 per year and a 50% reduction in clinic workload.