Optimisation of outpatient resource utilisation in cataract management

Area of Science:

• Ophthalmology
• Health Services Research

Background:

• Cataract surgery requires careful patient selection and management.
• The role of general practitioners and optometrists in initial diagnosis and referral is crucial.
• Pre-assessment clinics are a standard part of the surgical pathway, but their efficiency is debated.

Purpose of the Study:

• To evaluate the necessity of outpatient assessment before listing patients for cataract surgery.
• To determine if general practitioners can directly access surgical waiting lists.
• To assess the impact of pre-assessment clinics on patient management, even with long waiting times.

Main Methods:

• Prospective and retrospective analysis of patient data referred for cataract at Oxford Eye Hospital.
• Inclusion of 175 patients (75 prospective, 100 retrospective).

Main Results:

• Twenty-six percent of patients had misdiagnoses or additional issues impacting management.
• Diagnostic accuracy was similar between optometrists (73%) and general practitioners (75%).
• Pre-assessment clinics led to a change in management in only 4% of patients, often due to pupil dilatation.

Conclusions:

• Referral letters alone are insufficient for listing 1 in 4 patients due to diagnostic inaccuracies or complicating factors.
• Pre-assessment clinics provide minimal clinical benefit in changing patient management.
• Integrating surgical planning and implant power decisions into the initial outpatient consultation may render separate pre-assessment clinics unnecessary.