Cataract backlog: “Restoring sight is hugely important to overall wellbeing”

Mr Robert Morris talks with OT  about how Optegra is working to ease the burden on the NHS in the wake of COVID-19

Robert Morris
Optegra has received 2700 referrals from the NHS following the outbreak of the COVID-19 pandemic. OT speaks with Mr Robert Morris, a consultant ophthalmic surgeon for Optegra, about how the private eye care provider is working with the NHS to prevent sight loss.

How has Optegra been working to help the NHS?

Optegra carried out a business review around 18 months ago to look at where the greatest need for NHS services is. We identified cataract surgery and treatment of macular degeneration with anti-VEGF injections as the highest need areas.

We had previously been offering a much wider range of treatments, including glaucoma, eyelid surgery and other specialist areas. Our review established it would advantageous to concentrate on where the greatest clinical need was to deliver an efficient, cost effective high-quality service. This led us to focus on high volume cataract surgery and injections for macular degeneration.

Most glaucoma care is an outpatient service and in many areas of the country, including Hampshire, there is co-management of glaucoma with optometrists. Most glaucoma patients are managed with drops and complex glaucoma surgery is rarely indicated. That is much better done in the bigger hospitals where they can have a reasonable volume, with four or five on an operating list performed by a specialist glaucoma surgeon, with the opportunity for training, and for following up those patients in one centre.

How has COVID-19 affected the way care is offered?

It’s impacted it in a very positive way. What we do now is concentrate our NHS work into certain days and certain operating lists. We have an efficient cost-effective service with great clinical outcomes. We are delivering better value for money for the NHS.

Patients come to us through two routes. Some come because they are already on an NHS waiting list, but we are now receiving direct referrals from optometrists and GPs who have gone through the appropriate processes. That is delivering a much quicker service to patients so they are getting their cataracts treated sooner.

How does efficient cataract treatment affect the lives of patients?

Patients seek cataract surgery as blurred vision is affecting the quality of their life and many can no longer drive or read. Elderly patients who can’t drive will lose their independence. Cataract surgery improves their vision and gets them back driving, enabling them to be independent again which is hugely important. Elderly people who can’t see are at a higher risk of falls. Restoring sight is hugely important to overall wellbeing.

Elderly patients are often at home and if their vision is not good enough for them to watch television, read or use the computer then they feel disconnected and lonely. There are many reasons why cataract surgery is such an effective operation at improving quality of life.

It is so important to deliver a safe and efficient service. If you are efficient, you are cost effective and you can treat a high volume of patients. That means that you can deliver value for money for the NHS and treat more patients. On an all-day list we may be treating 25 cataract patients by improving our patient pathways. In many trusts where there is less opportunity for treating patients, lists may only have 10 - 12 patients each day.

Are there any other innovations Optegra has introduced following COVID-19?

One thing we have introduced that patients like is virtual consultations. We do this on Teams or Zoom. We will talk to patients and their relatives remotely so that we can assess if they would benefit from a full assessment for surgery. That means that when they come in they spend less time in the clinic. Many of our patients are vulnerable, so they are not as exposed as they may otherwise be.

Another important point in this COVID environment is that we have the space and the pathways so that when patients come to see us their contact to other people and the time spent in the clinic is minimal. We have been developing this for some time and since COVID we have fine-tuned it.

Both for optometrists and for patients, every quarter we are offering separate specific one-hour webinars. Optometrists can submit questions in advance as well as during the meetings. That has been hugely well-received. The beauty is instead of holding it locally at a clinic, people can log on from all over the country. If you organise a meeting locally, it can take a long time to finish work, drive to the venue, attend the meeting and return home. The attendance can be poor. For these online meetings the attendance is huge.

For an in-person talk, a really good evening might be 20 attendees. For a recent webinar I delivered, we had more than 75 people attend and stay for the whole time.

We have a huge cohort of elderly people receiving wet-AMD injections. It is the commonest cause of blindness in the UK. One of the initiatives that we have started in Manchester is that we are training nurses and optometrists to give the injections so we don’t have consultants delivering all of the injections. That means that we can free up the time of consultants to do more of the diagnosis and planning.

That is something that has been going on within the NHS for some time, but it is a new initiative for Optegra. It will make us more efficient and able to deal with a higher volume of patients.