Structures of Care

In the wake of the COVID-19 pandemic and long-term structural issues, the UK National Health Service (NHS) has been left facing serious problems, from funding shortfalls to huge waiting lists. As Imran Rahman points out in The Ophthalmologist, many of the patients on those waiting lists are in need of cataract treatment or other ophthalmic procedures (1). With that in mind, one hospital in Manchester is trying to build the systems needed to help both the NHS and patients in need of AMD treatment, cataract surgery, and refractive vision correction.

Optegra Eye Hospital Manchester focuses on high-volume and elective surgery that draws from both private and NHS patients – a strategy outlined by Optegra’s CEO, Peter Byloos (interviewed here by our sister publication, The New Optometrist) (2). The aim is to establish a successful business as well as provide secondary support for the NHS. The Manchester hospital is one of the busiest in the group, performing almost 8,500 cataract surgeries and 1,000 refractive lens exchanges in 2022 – that’s almost 20 percent of the surgical volume for the entire group of eleven hospitals and clinics.

On my visit, I could easily see why the company’s streamlined approach is popular with patients. The hospital’s systems are designed to make patient arrival as easy and efficient as possible – from pre-arrival telehealth consultations to dedicated spaces for AMD and surgical recovery. The emphasis throughout all aspects of the design and layout is on efficiency of throughput.

Such efficiency is necessary not only to ensure the viability of the business, but also to handle the sheer number of patients involved. As consultant ophthalmologist Sajjid Mahmood points out, when it comes to AMD, the “patient pool only ever increases'' as more of the population need regular injections to maintain visual acuity. Looking to the future, Mahmood is hopeful that the next generation of anti-VEGF drugs will allow for longer intervals between treatments, allowing healthcare systems to continue to manage those ever-increasing patient numbers. In the meantime, the Manchester hospital’s AMD clinic has expanded from three to four days a week (and will soon expand to five). As Mahmood explains, one of the things that makes this high-volume model work is the “optometrist-led, ophthalmologist-delivered” model of care. Rather than place the burden entirely on ophthalmologists, it’s necessary for teams to collaborate, with nurses, optometrists, and other health workers all involved with patient treatment.

The same model of efficiency, volume, and specialization applies to the hospital’s cataract and refractive options. Consultant ophthalmologist Shafiq Rehman, a cataract specialist, sees systems like Optegra’s as essential for helping NHS services but also ensuring patients get the best visual outcome. The NHS treatment pathway with a standard monofocal lens “provides basic care but there are more sophisticated options available to meet ever-increasing needs.” The NHS system simply doesn’t have the flexibility to provide the personalized outcomes that people increasingly request, says Rehman. And, just as cataract surgeons worldwide have pointed out, expectations have never been higher. When I bring this up, Rehman responds with a smile: “Expectations may be high, but I think we can meet them.”

The importance of the word “we” is brought home to me as I get to observe surgery. Here, Rehman, who tells me that he has performed around 3,000–4,000 cataract surgeries in a single year, is joined by a surgical team that works together seamlessly, prepping the patient, confirming the presurgical measurements, and – in one case – ensuring a nervous patient has their hand held throughout the entire lens exchange procedure. After a potentially tricky cataract surgery, Rehman says there is “a real argument for cataracts being done by a specialist” – and certainly, working at a facility like this seems a great way of getting the surgical experience necessary to become one.

As I walk out of the hospital at the end of my visit, I note that the line of patients coming in doesn’t look like it will be getting shorter any time soon.