Cataract surgery

Five year cataract surgical rate in Iran

PURPOSE

To determine the number of cataract surgeries per million population per year or the cataract surgical rate (CSR) in Iran for every year from 2000 to 2005 as part of the objectives of the Vision 2020 initiative by the World Health Organization (WHO) to eliminate cataract blindness.

METHODS

This study is part of the Iranian Cataract Surgery Survey, which was conducted as a retrospective cross-sectional study. All major cataract surgery centers and 10% of randomly selected minor centers throughout the nation were approached. Excluding the 2-week Iranian New Year holiday, 1 week per season between 2000 and 2005 (a total of 24 weeks) was selected for each center, and data concerning all cataract surgeries performed during these weeks were recorded by reviewing records of patients operated for cataracts.

RESULTS

A total of 13,409 surgical records from 2000 to 2005 were evaluated, and CSR was calculated for each year based on the population data obtained from the Statistical Center of Iran. CSR showed an increasing trend in Iran, rising from 526 (95% confidence interval: 352 to 700) in year 2000 to 1331 (95% confidence interval: 1084 to 1577) in 2005.

CONCLUSIONS

CSR has significantly increased in Iran in recent years but is still below the target suggested by WHO. Considering the age structure of the young population of Iran, the present CSR may suffice. However, it is necessary to implement plans to increase CSR and obviate obstacles to eliminating cataract blindness.

Independent sector treatment centres (ISTCS): early experience from an ophthalmology perspective

In 2001, the NHS plan concluded that there was a significant lack of capacity within current NHS structures to deliver adequate volumes of cataract surgery for England and Wales. The initial central 'solution' for this was to invite in overseas surgical teams to existing NHS centres for short-term surgical initiatives. However, with the advent of the Waiting, Booking and Choice Strategy, a target was set for treatment centers (TCs) to be carrying out an additional 250 000 inpatient/day-case episodes, across all specialties, by 2005. This paper outlines how these Ophthalmology TCs were commissioned, and some of the policy and medical agendas that surrounded their evolution. The concept of 'take or pay' contracts, which placed the onus on local Primary Care Trust organisations to provide the promised number of suitable cataract patients for the TCs, and the 'additionality' of medical and nursing staff are discussed. In September 2003, Netcare was awarded the contract to carry out 41 600 cataract procedures over a 5-year period in a mixture of mobile and fixed site units. Netcare's proposed patient care pathways are examined, as is the reality of its interaction with local Ophthalmology Departments and the response of the Royal College of Ophthalmologists to its standards of patient care. Although Netcare TCs may have contributed to reduced waiting times for cataract surgery in some districts, the quality of care provided by the Netcare TCs has yet to be established. There are ongoing concerns about both the continuity of care and the management of postoperative complications, as well as the economics of neighbouring NHS units.