For the first time, specialist ophthalmic services provider Optegra has been offering NHS patients a “treble” of cataract care at its eye hospital in Hampshire, UK, comprising drop-free surgery; pre-op consultation and treatment on the same day; and bilateral surgery. Optegra aims to roll out drop-free surgery to all its NHS patients in the UK in the coming weeks.
The Ophthalmologist sat down with Alastair Stuart, Optegra Medical Director and consultant ophthalmic surgeon, to discuss the thinking behind this new approach and how it has impacted patients so far.
What inspired this “treble” pilot scheme, and what are the benefits to patients compared to the traditional drop regimen?
Optegra has offered high-volume cataract surgery with very low complication rates for many years now, but we don’t want to stand still. Patient care, experience, and clinical outcomes are at the centre of everything we do, and we are always looking for ways to improve our pathway.
The benefits to the patient of steroid injections in place of post-operative eye drops are numerous. The feedback tells us that the four-week post-operative drop regime is difficult for them. There are side effects (stinging, red eyes) and it’s difficult for patients to self-administer the treatment, particularly elderly patients. Removing the drops makes the experience far easier for the patient.
Historically, the main concern about steroid injections at the time of cataract surgery has been intra-ocular pressure (IOP) rises, but recent research has shown that specific dosages of steroid given as a subconjunctival injection have an improved anti-inflammatory response compared to drops, with no rise in IOP (1).
What prompted your decision to introduce bilateral cataract surgery for NHS patients?
Bilateral cataract surgery has been part of our private pathway for many years and we are now in the process of reviewing this for NHS patients, beginning with this pilot scheme. There is a large body of evidence now showing that when intracameral antibiotics are used, bilateral cataract surgery is extremely safe.
And as well as the obvious logistical benefits of having two eyes treated on one day, there is a particular appeal for patients with strong prescriptions. If patients have to wait for weeks between two operations with significant anisometropia, it can be quite debilitating.
What adjustments were needed to move to pre-operative assessments and surgery on the same day?
The main challenge is the consenting process. It’s essential to give patients adequate time to consider the risks and benefits of the surgery. For this reason, we sent patients our cataract surgery information booklet prior to surgery day, and we called them a week before to discuss the benefits and risks of surgery. We based this on the published work of Harry Robert’s clinical team in Devon, who have described this same-day assessment and surgery model.
How have the outcomes compared to standard NHS cataract surgery?
The numbers in the pilot were too low to draw firm conclusions, but I was delighted with the results. The best part has been the reaction of the patients, who have been thrilled! One patient in the pilot was highly myopic and could not believe how his vision was transformed in such a short space of time.
We are now extending the drop-free surgery pilot to a minimum of 100 additional NHS patients so will have more outcomes and data to review.
Of course, each of these individual steps of “the treble” has its own evidence, but Optegra is the first to offer all three at the same time.
How else can the independent sector and the NHS collaborate to drive innovation?
There are significant challenges surrounding the provision of healthcare in the UK, and I believe that the independent sector can provide an extremely important and positive role. We safely treat a high number of patients, which helps to reduce waiting times and produces a large volume of clinical data to drive innovation and improvements.
I am also passionate about training the next generation of surgeons. As the number of cataract surgeries being performed in the independent sector increases, so does our responsibility to provide training to junior surgeons. We are already providing this, and are looking to significantly increase opportunities for junior surgeons to access training in our 17 hospitals across the country in 2025.
References
- NH Shorstein et al., “Triamcinolone Acetonide Subconjunctival Injection as Stand-alone Inflammation Prophylaxis after Phacoemulsification Cataract Surgery,” Ophthalmology, 131, 1145 (2024). PMID: 38582155.
