In the eye of the beholder

Professor John Sparrow discussed work to establish patient reported outcome measures (PROMs) for the management of cataracts at the College of Optometrists' annual conference, Optometry Tomorrow (18–19 March, Birmingham).

His presentation Cataract patient reported outcome measures and NICE guidelines – friend or foe? follows updated national recommendations for the management of cataracts that discourage restricting access to cataract surgery on the basis of visual acuity.

“Up until now visual acuity has been an important determinant of whether or not someone is referred for cataract surgery,” Professor Sparrow shared.

He emphasised that visual acuity is not a whole person measure and is difficult to translate into health economics.

A shift towards PROMs creates a new challenge because every person and cataract is different, Professor Sparrow observed.

“Cataracts are incredibly varied in their physical appearance and the things they do optically,” he added.

PROMs recognise that patients are the best judge of their own vision.

Professor Sparrow explained that his research group aimed to create a short, reliable, repeatable, unidimensional questionnaire that could be used to assess the impact that cataract surgery would have on a patient’s quality of life.

The resulting survey, Cat-PROM5, has been piloted in a national audit as a patient reported outcome measure.

Professor Sparrow confirmed that Medisoft is developing software that will be compatible with the survey, while the survey has also been translated for use in Wales.

When asked by an audience member if the questionnaire could be used by optometrists as a referral tool, Professor Sparrow responded that he thought Cat-PROM5 would “inevitably” be used for this purpose in the future.

“I think it is likely that a threshold will be developed over time for referral of patients into secondary care,” he explained.

Professor Sparrow highlighted that critics of Cat-PROM5 have suggested that the survey will simply be used to ration cataract surgery.

But he pointed out that rationing was already occurring on the basis of visual acuity.

“I think we should make rationing a bit more rational,” Professor Sparrow concluded.