National Ophthalmology Database

The Royal College of Ophthalmologists (RCOphth) runs an annual audit to monitor the outcomes of cataract surgery and age-related macular degeneration (AMD) services for the UK – the National Ophthalmology Database (NOD). 

There has been considerable growth in the amount of cataract activity in recent years, in part due to direct referral routes which give patients far more control over where they are referred, than in other specialties. Unsurprisingly, patients opt to wait for considerably less time by choosing independent providers: the mean waiting time for admitted ophthalmology for NHS patients is currently around 21 weeks at NHS providers compared to 8 weeks for independent providers.  

This disparity in access is shown in the plot below with many patients waiting far longer than necessary compared to others who live nearby. The size of each dot represents the number of completed admitted pathways in each Integrated Care Board (ICB) area with the y-axis showing the median waiting time at that ICB. Green dots represent patients waiting at independent providers and blue dots show patients waiting at NHS hospitals. 

While many patients are clearly choosing to wait for shorter periods, it is important that they also receive high quality care. PROMs data published above illustrates the transformative impact of cataract surgery with the overwhelming majority of patients reporting improved outcomes. The RCOphth publishes hospital level data from the NOD which provides further reassurance by looking at complication rates. 

Covering the period from April 2022 to March 2023, the latest NOD data contains data relating to NHS and independent providers. Just under 70% of NHS and independent hospitals listed on the NOD website have data relating to posterior capsule rupture (PCR) rates. In addition, over 60% of independent hospitals have submitted sufficient data about vision loss rates for publication, compared to 35% of NHS hospitals.  

In total, information relating to complication rates of around 250,000 operations carried out by independent providers is available on the NOD website, which accounts for around 60% of all operations with published information.  

The RCOphth applies a risk adjustment methodology to calculate complication rates that reflect the case mix of patients undergoing treatment.  

All independent hospitals with published complication rates are well within the expected limits calculated by the RCOphth.  

The RCOphth states that the “expected” PCR rate is 1.1%. The average PCR rate of independent providers is published on the NOD site is well below half that at under 0.4%.  

For vision loss, the RCOphth’s expected rate is 0.9%, and the average rate of independent providers published on the NOD site is again below half that expected rate at under 0.4%. 

While any complication is one too many, the combination of PROMs data, complication data and waiting data, shows that the experience of independent ophthalmology is one of rapid access, improved vision and low complications.