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Cataract scheme 'expensive over-reaction' say doctors
February 06, 2007Letter: ISTC program is an expensive option
The independent sector treatment centre (ISTC) scheme for NHS cataract services was an expensive over-reaction to the need to increase rates of cataract surgery, say senior doctors in this week's BMJ.
Many ophthalmology departments had improved cataract surgery pathways before the ISTC programme was proposed, writes Consultant Ophthalmic Surgeon, Simon Kelly in a letter signed by the President and Vice President of the Royal College of Ophthalmologists and the Chair of the BMA's Ophthalmic Group Committee.
Had the Department of Health followed the advice of clinicians, the royal colleges, and the BMA when the cataract and other ISTC schemes were proposed, improved access to cataract surgery would have been realised with much less expenditure, without adverse effects on surgical training, and without destabilising NHS eye departments.
However, an alternative direction was taken, they say. And despite the paucity of clinical outcome data, and the lack of evidence of cost effectiveness of phase 1 of the ISTC programme, further investment in cataract surgical facilities continues in phase 2.
Meanwhile, for long term stability of the service, the best option for the public is to support local NHS units, which brought down cataract waiting times, which patients need to call on in an emergency or for chronic eye disease, and which train the next generation of surgeons while meeting waiting time targets.
A constructive partnership of clinicians, managers, and commissioners is a surer way to achieve sustained improvements in access and quality of care, rather than centrally imposed initiatives and diktat, such as the needless cataract ISTCs, they conclude.
BMJ-British Medical Journal
Had the Department of Health followed the advice of clinicians, the royal colleges, and the BMA when the cataract and other ISTC schemes were proposed, improved access to cataract surgery would have been realised with much less expenditure, without adverse effects on surgical training, and without destabilising NHS eye departments.
However, an alternative direction was taken, they say. And despite the paucity of clinical outcome data, and the lack of evidence of cost effectiveness of phase 1 of the ISTC programme, further investment in cataract surgical facilities continues in phase 2.
Meanwhile, for long term stability of the service, the best option for the public is to support local NHS units, which brought down cataract waiting times, which patients need to call on in an emergency or for chronic eye disease, and which train the next generation of surgeons while meeting waiting time targets.
A constructive partnership of clinicians, managers, and commissioners is a surer way to achieve sustained improvements in access and quality of care, rather than centrally imposed initiatives and diktat, such as the needless cataract ISTCs, they conclude.
BMJ-British Medical Journal
Cataract Current Events and Cataract News RSSCataract surgery does not appear associated with worsening of age-related macular degeneration
Age-related macular degeneration does not appear to progress at a higher rate among individuals who have had surgery to treat cataract, contrary to previous reports that treating one cause of vision loss worsens the other.
Cataract surgery helps AMD patients; steroid improves DME; online eye health forum
This month's Ophthalmology, the journal of the American Academy of Ophthalmology (Academy) reports on a national study that finds cataract surgery is likely to benefit patients with age-related macular degeneration (AMD) at all stages of the disease, on a clinical trial showing that the steroid triamcinolone may be effective in advanced diabetic macular edema (DME) patients when standard treatment fails, and on the public's use of two Academy-sponsored online eye health forums.
Study predicts 40 percent increase in blindness in Nigeria by 2020
By 2020, 1.4 million Nigerians over age 40 will lose their sight, and the vast majority of the causes are either preventable or treatable, according to the Nigeria National Blindness and Visual Impairment Study Group.
Market based reforms have not harmed equity in the NHS, say researchers
Recent NHS reforms, such as the introduction of patient choice and provider competition, have not had a deleterious impact on equity with respect to waiting times for elective surgery in England.
Gene mutation responsible for premature skin aging disease identified
In the new print issue of Nature Genetics, scientists in Singapore and Germany report that mutations in the PYCR1 gene cause the rare genetic condition that results in premature skin aging and that is known as "wrinkly skin syndrome."
Drug for urination difficulties linked with complications after cataract surgery
Use of the medication tamsulosin to treat male urination difficulties within two weeks of cataract surgery is associated with an increased risk of serious postoperative ophthalmic adverse events such as retinal detachment or lost lens.
Vigorous Exercise May Help Prevent Vision Loss
There's another reason to dust off those running shoes. Vigorous exercise may help prevent vision loss, according to a pair of studies from the U.S. Department of Energy's Lawrence Berkeley National Laboratory.
Melatonin may save eyesight in inflammatory disease
Current research suggests that melatonin therapy may help treat uveitis, a common inflammatory eye disease. The related report by Sande et al., "Therapeutic Effect of Melatonin in Experimental Uveitis," appears in the December issue of The American Journal of Pathology.
Vision loss more common in people with diabetes
Visual impairment appears to be more common in people with diabetes than in those without the disease, according to a report in the October issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
Corneal transplant technique shows promise in children
For infants and children with blinding diseases of the cornea, a sophisticated new corneal transplantation technique offers the hope of improving vision while overcoming the technical difficulty and low success rate of traditional penetrating keratoplasty (PK) in children, according to reports in the current issue of the Journal of AAPOS (American Association for Pediatric Ophthalmology and Strabismus).
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