Commissioning Policy Individual Funding Request

Transcription

1 Commissioning Policy Individual Funding Request Cataract Surgery Criteria Based Access Policy Date Adopted: 19 th April 2017 Version: Individual Funding Request Team - A partnership between Bristol, North Somerset and South Gloucestershire Clinical Commissioning Groups Commissioning Group

2 Document Control Title of document Cataract Surgery Policy Authors job title(s) IFR Manager Document version v Supersedes Cataract (Referral for Assessment of Surgical Treatment) v Clinical approval November 2016 Discussion and Approval by 14 th December 2016 Clinical Policy Review Group (CPRG) Discussion and Approval by CCG 28 th February 2017 Board Date of Adoption 19 th April 2017 Publication/issue date 19 th April 2017 Review date April 2020 Equality and Impact Assessment Page 2

3 THIS IS A CRITERIA BASED ACCESS POLICY TREATMENT MAY BE PROVIDED WHERE PATIENTS MEET THE CRITERIA BELOW THIS POLICY RELATES TO ALL PATIENTS Cataract Surgery Policy Statement & Date of Adoption: 19 th April 2017 Cataract surgery is subject to this restricted policy. General Principles Treatment should only be given in line with these general principles. Where patients are unable to meet these principles in addition to the specific treatment criteria set out in this policy, funding approval may be sought from the CCG Individual Funding Panel by submission of an IFR application. 1. Each Clinician reviewing the patient for this condition should assess the patients against the criteria within this policy prior to treatment. 2. Patients will only meet the criteria within this policy where there is evidence that the treatment requested is effective and the patient has the potential to benefit from the proposed treatment. Where the patient has previously been provided with the treatment with limited or diminishing benefit, it is unlikely that they will qualify for further treatment and the IFR team should be approached for advice. 3. Patients with an elevated BMI of 30 or more are likely to receive fewer benefits from surgery and should be encouraged to lose weight further prior to seeking surgery. In addition, the risks of surgery are significantly increased. (Thelwall, 2015) 4. Patients who are smokers should be referred to smoking cessation services in order to reduce the risk of surgery and improve healing. (Loof S., 2014) Background Cataract surgery is a procedure used to treat cataracts, where changes in the lens of the eye cause cloudy, blurry, or misty vision. It's the most common operation performed in the UK. Cataracts occur when changes in the lens of the eye cause it to become less transparent. The lens is the crystalline structure that sits just behind the pupil, which is the black circle in the centre of the eye. Cataracts sometimes start to develop in a person's lens as they get older (age-related cataracts), stopping some of the light reaching the retina. This can affect your vision, making it become increasingly cloudy, blurry, or misty. Although cataracts are often associated with age, in rare cases babies are born with cataracts or young children can develop them (childhood cataracts). Page 3

4 When is cataract surgery recommended? Slight cloudiness of the lens is a normal part of ageing. Significant cloudiness, or cataracts, usually get slowly worse over time. Surgery to remove them is the only way to restore vision. However, surgery isn't necessary if the vision isn't significantly affected. The current commonly used objective measurements of visual acuity do not always accurately reflect a patient s degree of visual disability. The level of visual acuity that an individual patient requires to function without altering their lifestyle is very variable. A visual acuity of 6/12 or better [Snellen], 0.30 [LogMAR] in the worst eye normally allows a patient to function without significant visual difficulties. Some patients may undertake activities where improvement to better than 6/10 is an essential requirement e.g. to enable them to continue activities of daily living. Patients should be offered to opportunity to consider a Cataracts Shared Decision Aid prior to referral and prior to treatment where appropriate. (Right Care) If immediate treatment isn't necessary because the patient doesn t qualify for treatment or they decide to wait before having surgery, other measures may be helpful in the meantime, such as: new glasses brighter lighting anti-glare sunglasses magnifying lenses 95% of patients will achieve outcomes of 6/12 or better. (Royal College of Opthamologists, 2015) Risks The risk of serious complications developing as a result of cataract surgery is small. The most common complication is a condition called posterior capsule opacification (PCO), which can cause the vision to become cloudy again. In PCO, a skin or membrane grows over the back of the lens implant months or years later. Other risks or complications of cataract surgery are much rarer and can include: tearing of the lens capsule, the "pocket" that holds the lens in place all or some of the cataract dropping into the back of the eye inability to remove all of the cataract or insert a lens implant infection or bleeding in the eye Most complications that can potentially develop after cataract surgery can be treated with medication or further surgery, and don't usually have a long-term impact on the vision. Page 4

5 However, there's a very small risk around 1 in 1,000 of permanent sight loss in the treated eye as a direct result of the operation. (NHS Choices, 2016) Visual Acuity Scale The following table compares different visual acuity notations. US notation 6 meter notation Decimal notation MAR logmar VAS 20/10 6/ /12.5 6/ /16 6/ /20 6/ /25 6/ /32 6/ /40 6/ /50 6/ /63 6/ /80 6/ /100 6/ /125 6/ /160 6/ /200 6/ /250 6/ /320 6/ /400 6/ /500 6/ (Precision Vision, 2016) Page 5

6 Policy - Criteria to Access Treatment CRITERIA BASED ACCESS Surgical treatment will only be provided by the CCG for patients meeting criteria set out below. Primary/Community Care Including Optometrist/Opticians Before making a referral to a surgical provider, the GP and/or Optometrist must confirm that: 1. The patient understands that the purpose of referral is for assessment of surgery. AND 2. The patient wishes to have surgery if it is deemed appropriate and offered as a treatment option. (Right Care) Confirmation of the above criteria should be included in the GP referrals letter. Primary Care should also ensure that their referral letter details how the patient meets the below criteria also. Secondary Care When assessing a patient for surgery, the surgical provider must assess the patient and only offer cataract surgery where: 1. The proposed surgery will in all likelihood sufficiently improve the visual acuity of the patient. AND 2. The affected eye which it is proposed to operate on must have: a. A recorded visual acuity poorer than 6/9.5 attributable to a lens opacity i.e. the patient has a VA ranging from 6/12 to 6/150 due to a cataract. This applies when considering surgery for both first and second eye cataracts. OR b. A recorded visual acuity of 6/9.5 or better (ranging from 6/3 to 6/9.5) attributable to a lens opacity which causes significant functional impairment [SFI]. SFI is defined by the BNSSG Health Community as: Symptoms preventing the patient fulfilling routine work or educational responsibilities Symptoms preventing the patient carrying out routine domestic or carer activities Examples of SFI can include: i. Patients experiencing significant glare and dazzle in daylight or difficulties with night vision particularly whilst driving and the patient does not meet the Driving and Licensing Authority (DVLA) minimum sight requirements due to the cataract (DVLA, 2016); Page 6

7 ii. Patients require enhanced vision for employment purposes such as Group 2 licence holders (bus and lorry drivers) who require vision of 6/7.5 in their better eye and 6/60 in the other eye. Please note that this list is not exhaustive and evidence to support SFI must be included in the referral letter and patient notes. Cataract surgery/lens extraction should not normally be performed solely for the purpose of correcting longstanding pre-existing myopia or hypermetropia. Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes exceptional circumstances exist that warrant deviation from the rule of this policy. Individual cases will be reviewed at the CCG s Individual Funding Request Panel upon receipt of a completed application form from the patient s GP, consultant or clinician. Applications cannot be considered from patients personally. If you would like further copies of this policy or need it in another format, such as Braille or another language, please contact the Patient Advice and Liaison Service on or Connected Policies Multi Focal Lenses - Treatment will not be offered under this policy. Clinician s should refer to the intervention specific policy. This policy has been developed with the aid of the following references: DVLA. (2016, November 8). Cataracts and driving. Retrieved from Loof S., D. B. (2014). Perioperative complications in smokers and the impact of smoking cessation interventions [Dutch]. Tijdschrift voor Geneeskunde, vol./is. 70/4( NHS Choices. (2016, February 21). Cataract Surgery. Retrieved from NHS Choices: Precision Vision. (2016). Snellen Eye Test Charts Interpretation. Retrieved November 7, 2016, from Precision Vision: Right Care. (n.d.). Cataracts Decision Aid. Retrieved November 8, 2016, from Shared Decision Aid Page 7

8 Right Care : Royal College of Opthamologists. (2015, February). Commissioning Guide - Cataract Surgery. Retrieved from RCOpath: Guide-Cataract-Surgery-Final-February-2015.pdf Thelwall, S. P. (2015). Impact of obesity on the risk of wound infection following surgery: results from a nationwide prospective multicentre cohort study in England. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases,, vol. 21, no. 11, p e1. Approved by (committee): Clinical Policy Review Group Date Adopted: 19 th April 2017 Version: Produced by (Title) EIA Completion Date: Review Date: Commissioning Manager Individual Funding Undertaken by (Title): Earliest of either NICE publication or three years from approval. CATEGORY VERSION CATEGORY VERSION CATEGORY VERSION Bristol Criteria Based North Criteria Based South Criteria Based Access Somerset Access Gloucestershire Access Page 8