Opposition to new clinical standard for cataract surgery

For the first time, the Australian Commission on Safety and Quality in Health Care (ACSQHC) is developing a standard for cataract surgery – Australia’s most common elective procedure – which will see it become the 10th medical condition to receive a formalised clinical standard in the country.While not legally binding or mandatory, the ACSQHC’s draft consultation outlines eight ‘quality statents’ that highlight priority areas for improvent in cataract surgery. It also describes the level of care expected, and defines clinical pathways in line with current best evidence.The document came in response to a 2017 recommendation in the Second Australian Atlas of Healthcare Variation, which found that while Australia had double the cataract surgery rate of New Zealand, it lagged behind other developed nations such as France, the Netherlands and the US. It also reported a 1.6-fold geographical variation across local areas, and that the rate of cataract surgery for Indigenous Australians was 17% lower than other Australians.{{quote-A:R-W:450-I:2-Q: Snellen acuity is unreliable and therefore has the potential to be misleading. Some patients are asymptomatic and record good Snellen acuity until they drive into the sun and the internal light scatter of the crystalline lens creates a white out -WHO:Dr Peter Sumich, ASO}} ASO as well as RANZCO – the latter of which is not yet prepared to publicly release its submission – were among more than 40 organisations to respond to the draft consultation document.In its submission provided to Insight, ASO opposed part of an ACSQHC ‘quality statent’ that referred to use of the Snellen Chart to measure visual acuity when examining for indicators of cataract surgery.In the submission, ASO president Dr Peter Sumich called for its roval from the inidication criteria, stating Snellen acuity was an “outdated” measure of visual function and failed to capture real world conditions.“Snellen acuity is unreliable and therefore has the potential to be misleading. Some patients are asymptomatic and record good Snellen acuity until they drive into the sun and the internal light scatter of the crystalline lens creates a white out,” Sumich said.“It should play no part in cataract surgery indications in 2019. The best indication for cataract surgery comes from consideration of visual quality and symptoms as above, and the visual dand of every individual patient.”Meanwhile, Professor Stephen Duckett, from independent think tank the Grattan Institute, also lodged a submission, with a broad focus on hospital accountability and transparency to help address geographical variation and overall service.In proposals he expects will prompt opposition from segments of the ophthalmic community, Duckett called for all public and private cataract surgery providers to make public their wait times, patient outcomes and number of operations performed.“If Grattan’s ideas are accepted, we should begin to see improvents in waiting times and outcomes as hospitals are held to account in the court of public opinion, and by exposure of their inadequacies to their peers,” he told Croakey.The ACSQHC’s six-week consultation period ended on 5 April. Submissions are being considered before a final document will be put before the commission’s board.