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King C, Botcherby EJ, Adams M, Maling SJ. Implementing immediate sequential bilateral cataract surgery at Buckinghamshire Healthcare NHS Trust. Eye (Lond) 2024:10.1038/s41433-024-03202-1. [PMID: 38977819 DOI: 10.1038/s41433-024-03202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 05/29/2024] [Accepted: 06/20/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND/OBJECTIVES Immediate sequential bilateral cataract surgery (ISBCS) was first introduced into NICE guidelines in 2017. In this approach, patients undergo cataract surgery on both eyes on the same day. Although increasingly popular, only 0.5% of all cataract operations nationally are performed using this approach. We redesigned our service to routinely offer ISBCS and are now one of the leading NHS providers of ISBCS in the UK. We audited our cataract operations in 2022 and report our initial experiences with ISBCS here. SUBJECTS/METHODS We redesigned our cataract service to routinely offer ISBCS on the NHS. We audited all cataract operations performed in calendar year 2022. RESULTS We performed 4652 NHS cataract operations including 498 (10.7%) operations on 249 patients using the ISBCS approach. Trainee surgeons performed 32.5% of these cases. There were two intraoperative complications, both during the second eye operation. One was a suspected suprachoroidal haemorrhage and the other was a posterior capsular rupture post lens implantation. Post-operatively there was one case of retinal detachment requiring vitrectomy following uncomplicated ISBCS and five cases of Irvine-Gass syndrome that were managed medically. CONCLUSIONS From this data, ISBCS does not pose a greater risk to patients in terms of complications. Allowing trainees to operate on ISBCS cases improves the trainee experience. With appropriate pre-operative counselling, patients listed for unilateral surgery can be converted to ISBCS on the day of operation to fully utilise theatre capacity. Patients listed for ISBCS can also be converted to unilateral surgery on the day of operation when surgeons need time to deal with complications safely.
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Affiliation(s)
- Christopher King
- Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | | | - Mike Adams
- Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - Sarah Jane Maling
- Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK.
- Chair of Training for UK, Royal College of Ophthalmology, Ophthalmology, UK.
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Krijgsheld M, Schmidt EJET, Levels E, Schuurmans MMJ. Healthcare professionals as change agents: Factors influencing bottom-up, personal initiatives on appropriate care, a qualitative study in the Netherlands. Health Policy 2024; 147:105120. [PMID: 38981279 DOI: 10.1016/j.healthpol.2024.105120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/25/2024] [Accepted: 06/29/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Healthcare organisations face multiple challenges, often conceptualised as appropriate care. It requires change on different levels: healthcare systems (macro), healthcare organisations (meso), and healthcare professionals (micro). This study focuses on bottom-up changes initiated by healthcare professionals. The aim is to investigate hindering and stimulating factors healthcare professionals experience. MATERIALS AND METHODS The study used a qualitative design with purposive sampling of eight Dutch healthcare professionals who initiated changes. We conducted online interviews and used Atlas TI with a combination of open, axial, and selective coding for data analysis. RESULTS The results indicate that professionals are often mission-driven when they initiate change, support from clients and peers may help them overcome barriers. Conversely, peers who feel threatened in their autonomy hinder initiatives of professionals, especially when their changes have financial consequences for their organization. CONCLUSION Aligning and integrating macro- and micro-level initiatives is crucial to advancing the movement towards appropriate care and stimulating bottom-up initiatives of healthcare professionals. More research remained needed, in particular studies on the hindering or stimulating role of employers and healthcare professionals' representatives, and the adoption of the concept of appropriate care by patients.
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Affiliation(s)
- Marcel Krijgsheld
- School of Governance, Utrecht University, Bijlhouwerstraat 6, 3511 ZC, Utrecht, the Netherlands.
| | | | - Edwin Levels
- Dutch Healthcare Authority, Utrecht, the Netherlands
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Zhang R, Hutnik CML. Trends in immediate sequential bilateral cataract surgery in Ontario. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00128-5. [PMID: 38901468 DOI: 10.1016/j.jcjo.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/12/2024] [Accepted: 04/14/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Because of increased evidence for safety and increased demands, there appears to be a recent adoption and endorsement of immediate sequential bilateral cataract surgery (ISBCS). This study aims to determine whether a paradigm shift has occurred in the delivery of cataract surgery in the province of Ontario and its the extent, if any, and to analyze the current role of ISBCS. DESIGN Retrospective health records analysis. METHODS We analyzed aggregate Ontario Health Insurance Plan claim counts for cataract surgeries between 2016 and 2022, categorizing cases into unilateral, ISBCS, and delayed sequential bilateral cataract surgery (DSBCS) cases. We examined trends, compared wait times for second surgeries in the DSBCS cohort with wait times for first surgeries, and used previously published cost estimates for ISBCS to estimate annual savings in Ontario. RESULTS There were 1,122 ISBCS cases in 2016, which increased sixfold during the pandemic (2020-2021) and further increased to 11,876 cases in 2022. Unilateral and DSBCS cases decreased during the pandemic but rebounded in 2022 to 102% and 153% of baseline, respectively. ISBCS increased from 1% to 10%, unilateral cases decreased from 41% to 29% of total cases, and DSBCS increased from 58% to 61%. Median wait for patients' first and second surgeries increased from 65 to 87 days and 28 to 33 days, respectively. Using estimates, ISBCS saved approximately $19 million in 2022. CONCLUSION Our study demonstrates a paradigm shift in Ontario in favour of ISBCS. ISBCS also may be a strategy to reduce increasing wait times while saving health care system dollars.
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Affiliation(s)
- Richard Zhang
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - Cindy M L Hutnik
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, ON; Ivey Eye Institute, Department of Ophthalmology, St. Joseph's Hospital, London, ON.
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Jong JLZ, Tan JHY, Wang H. Sustained practice of immediate sequential bilateral cataract surgery (ISBCS) in a post-COVID era. Eur J Ophthalmol 2024:11206721241255762. [PMID: 38803197 DOI: 10.1177/11206721241255762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Affiliation(s)
- Joel L Z Jong
- Medical School, Academic Unit of Medical Education, University of Sheffield, Sheffield, UK
- Ophthalmology Department, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Trust, Sheffield, UK
| | - Jennifer H Y Tan
- Ophthalmology Department, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Trust, Sheffield, UK
| | - Haoyu Wang
- Ophthalmology Department, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Trust, Sheffield, UK
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Pollmann AS, Nguyen MTD, Keyeutat M, Danis É, Durr GM, Agoumi Y, Jabbour S. Refractive outcomes of immediately sequential bilateral cataract surgery in eyes with long and short axial lengths. BMC Ophthalmol 2024; 24:77. [PMID: 38378504 PMCID: PMC10877801 DOI: 10.1186/s12886-024-03347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024] Open
Abstract
PURPOSE To report the refractive outcomes of long (≥25.00 mm) and short (≤22.00 mm) axial length (AL) eyes undergoing immediately sequential bilateral cataract surgery (ISBCS). METHODS In this retrospective cohort study, patients who underwent ISBCS were identified and eyes of patients with bilateral long and short ALs were included. Pre- and postoperative biometry, autorefraction, and ocular comorbidities or complications were recorded. The primary outcome was the mean refractive prediction error. RESULTS Thirty-seven patients (74 eyes) with long ALs and 18 patients (36 eyes) with short ALs were included. The means ± standard deviations of the ALs were 26.40 ± 1.38 mm and 21.44 ± 0.46 mm in the long and short AL groups, respectively. In long AL eyes, the mean absolute error from the biometry-predicted refraction was - 0.16 ± 0.46 D, corresponding to 74% of eyes achieving a refraction within ±0.50 D of the predicted value. In short AL eyes, the mean absolute error was - 0.63 ± 0.73 D, corresponding to 44% of eyes achieving a refraction within ±0.50 D of the predicted value. Eight (44.4%) patients with short AL eyes had a myopic deviation greater than ±0.50 D from the predicted result in both eyes. CONCLUSIONS Compared to patients with long AL eyes, ISBCS in patients with short ALs had a wider variance in refractive outcome and a lower rate of achieving a postoperative refraction within ±0.50 D of the predicted target.
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Affiliation(s)
- André S Pollmann
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet St, Montréal, Quebec, H2X 3E4, Canada.
| | - Michael Trong Duc Nguyen
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet St, Montréal, Quebec, H2X 3E4, Canada
| | - Milime Keyeutat
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet St, Montréal, Quebec, H2X 3E4, Canada
| | - Éliane Danis
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Georges M Durr
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet St, Montréal, Quebec, H2X 3E4, Canada
| | - Younes Agoumi
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet St, Montréal, Quebec, H2X 3E4, Canada
| | - Samir Jabbour
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet St, Montréal, Quebec, H2X 3E4, Canada
- Department of Ophthalmology, McGill University, Montréal, Canada
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Ting DSJ, Buchan JC. Equity, access, and carbon cost-effectiveness of bilateral cataract surgery. Lancet 2024; 403:353-354. [PMID: 38280774 DOI: 10.1016/s0140-6736(23)01923-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/08/2023] [Indexed: 01/29/2024]
Affiliation(s)
- Darren S J Ting
- Birmingham and Midland Eye Centre, Birmingham, UK; Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK.
| | - John C Buchan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Lin JC, Greenberg PB. Equity, access, and carbon cost-effectiveness of bilateral cataract surgery. Lancet 2024; 403:353. [PMID: 38280775 DOI: 10.1016/s0140-6736(23)01922-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/08/2023] [Indexed: 01/29/2024]
Affiliation(s)
- John C Lin
- Division of Ophthalmology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Paul B Greenberg
- Division of Ophthalmology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA; Section of Ophthalmology, Providence VA Medical Center, Providence, RI, USA.
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Spekreijse L, van den Biggelaar F, Nuijts R. Equity, access, and carbon cost-effectiveness of bilateral cataract surgery - Authors' reply. Lancet 2024; 403:354. [PMID: 38280777 DOI: 10.1016/s0140-6736(23)01921-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/08/2023] [Indexed: 01/29/2024]
Affiliation(s)
- Lindsay Spekreijse
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht 6229HX, Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.
| | - Frank van den Biggelaar
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht 6229HX, Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Rudy Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht 6229HX, Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands; Department of Ophthalmology, Zuyderland Medical Center, Heerlen, Netherlands
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Aiello F, Gallo Afflitto G, Leviste K, Swaminathan SS, Yoo SH, Findl O, Maurino V, Nucci C. Immediate sequential vs delayed sequential bilateral cataract surgery: systematic review and meta-analysis. J Cataract Refract Surg 2023; 49:1168-1179. [PMID: 37276258 DOI: 10.1097/j.jcrs.0000000000001230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Abstract
The main aim of this systematic review and meta-analysis was to evaluate the safety and efficacy profile of immediate sequential bilateral cataract surgery (ISBCS) compared with delayed sequential bilateral cataract surgery (DSBCS). MEDLINE Ovid, EMBASE, and CENTRAL databases were searched. Outcome measures were postoperative visual acuity, postoperative spherical equivalent (refractive outcome), endophthalmitis, corneal edema, pseudophakic macular edema, and posterior capsule rupture (PCR). 13 articles met criteria for final inclusion. A total of 11 068 622 participants (18 802 043 eyes) were included. No statistically significant differences between ISBCS and DSBCS were identified in all the postoperative outcomes evaluated. However, a higher risk for PCR was identified in the ISBCS group from the pooled analysis of nonrandomized studies (risk ratio, 1.34, 95% CI, 1.08-1.67, P = .0081). In our view, the ISBCS approach has an acceptable safety-efficacy profile, comparable with DSBCS. Future investigations are warranted, with a focus on the analysis of risk factors for surgical complications, patient-reported outcome-measures, and cost effectiveness.
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Affiliation(s)
- Francesco Aiello
- From the Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (Aiello, Gallo Afflitto, Nucci); Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida (Gallo Afflitto, Leviste, Swaminathan, Yoo); Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (Maurino); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl)
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