ESCRS - PP04.05 - An Investigation Of Post-Operative Cataract Surgery Care By Optometrists To Allow Direct Community Discharge From A Public Health Sector University Hospital

An Investigation Of Post-Operative Cataract Surgery Care By Optometrists To Allow Direct Community Discharge From A Public Health Sector University Hospital

Published 2022 - 40th Congress of the ESCRS

Reference: PP04.05 | Type: ESCRS 2022 - Posters | DOI: 10.82333/gnh8-d712

Authors: Sancy Low 1 , Jeffrey Lam* 2 , Edward Bloch 2 , Uma Patel 3 , Charles Greenwood 4 , Ashmal Jameel 2 , Maninder Bhogal 2 , David O'Brart 2 , Seema Verma 2

1Ophthalmology,Guys and St. Thomas' NHS Foundation Trust,LONDON,United Kingdom, 2Ophthalmology,Guys and St. Thomas' NHS Foundation Trust,London,United Kingdom, 3Primary Ophthalmic Solutions,London,United Kingdom, 4Primary Ophthamic Solutions,London,United Kingdom

Purpose

During the Covid-19 pandemic a pathway was developed for community optometrists to provide direct care for routine uncomplicated post-operative cataract surgery (CS) patients in anticipation of the need for greater capacity during Covid-19 recovery of elective CS services. This study was undertaken to evaluate initial patient uptake, data returns, and visual outcomes of patients referred to this service.

Setting

Guy’s and St. Thomas’ NHS Foundation Trust, a university public health sector National Health Service (NHS) hospital, Community Optometric practices in Southeast London (SEL).

Methods

Retrospective data analysis of 270 patients seen between May 2021-Feb 2022: 97 males, 173 females, average age 71 years. 152 optometrists from 57 practices completed their accreditation training. A web-based digital portal on an electronic medical record system (OpenEyesTM) allowed feedback to be sent by the community optometrist to the operating surgeons. Three main outcomes were collected: completion of direct discharge to SEL, listing for second eye surgery, and identification of post-operative complications requiring referral back to hospital care. Visual acuity and refraction data was also extracted for analysis. Where optometrists’ data return was not available, patients were contacted by telephone to ascertain if they had been seen.

Results

248 patients (92%) referred to SEL completed their review but the hospital did not receive returns data in 19 patients (7%). Ninety optometrists from 36 practices participated in the post-operative reviews. Out of 229 patients (85%) seen and with data returns, visual acuity improved from 0.45 ±0.42 pre-operatively to 0.06 ±0.16 logMAR post-operatively, with 67% and 93% achieving refractive outcome within ±0.5DS and ±1DS of targeted outcome. Sixty-nine patients (25%) were directly listed for second eye surgery. Fourteen patients (5%) were referred back for post-operative complications: 11 seen via eye emergency and 3 routine referrals (7 cystoid macular oedema, 2 unexplained reduced vision, 1 diplopia, 1 corneal oedema, 3 anterior uveitis).

Conclusions

This study demonstrates proof-of-concept of a city-based, optometrist-led, post-operative follow-up after uncomplicated cataract surgery, provided by a community-based service. There were no significant adverse clinical outcomes although up to 15% of cases required administrative support to chase up returns data and clinical outcomes. We observed low patient attrition, low complication rates, efficient listing for second eye surgery and well-documented post-operative outcomes, compliant with national standards of care. As clinical workloads increase during the Covid-19 recovery, integration of community services appears to be a safe, effective and efficient use of resources to streamline delivery of ophthalmic care in the United Kingdom.