Optimising Hospital-Funded Contact Lens Provision At Frimley Park Hospital: Targeting Resources To Maximise Patient Benefit And Cost Effectiveness

Hospital eye services provide contact lenses for patients whose visual needs cannot be adequately met with spectacles alone, typically due to irregular corneal surfaces, high ametropia, significant anisometropia, aphakia, or post-keratoplasty irregular astigmatism. Current criteria at Frimley Park Hospital include: high refractive error ≥8 dioptres; anisometropia ≥4 dioptres; aphakia; keratoconus; history of penetrating keratoplasty; and bandage or cosmetic lenses.

The NHS Trust subsidises patients' contact lenses at an annual cost exceeding £100,000, which is not centrally reimbursed. To ensure equitable provision to patients with greatest clinical need, whilst delivering cost efficiencies, refined eligibility criteria were proposed.

To implement refined eligibility criteria ensuring hospital-funded contact lenses are offered to patients with greatest clinical need whilst achieving cost savings.

Refined eligibility criteria:

• Irregular astigmatism (keratoconus, pellucid marginal degeneration, post-keratoplasty, microbial keratitis scarring): Best spectacle-corrected Snellen VA must be worse than 6/9 in both eyes causing significant functional difficulty. 
• Replacement lenses: maximum one replacement episode per 12-month period.

A retrospective review of electronic records of 386 patients currently receiving hospital-funded contact lenses was undertaken.

Data collected included underlying ocular condition, best spectacle-corrected Snellen visual acuity, and replacement lens requirements. Patients were categorised into three outcomes: remain on contract; discharge from contract; or require consultation (face-to-face or telephone) to determine eligibility.

Mean patient age was 46 years old. Keratoconus was the most prevalent diagnosis (68%, n=263), followed by corneal scarring secondary to microbial or herpetic keratitis (n=21) or other underlying diagnoses. 1.8% of patients did not meet the diagnostic criteria.

Best spectacle-corrected Snellen visual acuity was worse than 6/9 in both eyes in 26.5% of patients (n=47).

Following application of refined criteria, 48% (n=186) met the threshold to remain on contract. 34% (n=130) were recommended to come off the contract, with the option to self-fund. 70 patients were identified as having missing information and were thought to benefit from further telephone or video consultation. Two patient were deceased.

Application of refined eligibility criteria would result in approximately half of patients (48%) continuing to receive funded contact lenses, with 34% recommended for discharge from the contract. Only 26.5% had best spectacle-corrected Snellen VA worse than 6/9 in both eyes, suggesting many patients may achieve functional vision with spectacles alone.

Implementation of the new criteria has potential to deliver meaningful cost savings.

Assessment of functional difficulty for patients was variable; some requiring contact lenses despite visual acuities better than 6/9; whilst others did not find benefit or were unable to tolerate contact lenses. This underscores the need for individualised clinical assessment alongside objective thresholds.