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RANZCO won’t endorse new Cataract Clinical Care Standard

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The newly-launched national Cataract Clinical Care Standard has failed to win the full support of RANZCO, with the college citing two major issues with the finalised document.

In a memo to fellows and trainees, president Professor Nitin Verma said RANZCO won’t endorse the standard because it didn’t agree with the inclusion of 6/12 visual acuity as a measure for cataract, and the recommendation to offer all patients bilateral same day surgery.

The Australian Commission for Safety and Quality in Health Care (ACSQHC) has spent several years developing the inaugural Cataract Clinical Care Standard, which was released during a live webinar on Tuesday 17 August.

UPDATE: Since publication of this article, the ACSQHC issued its own response. 

Prof Nitin Verma.

RANZCO applauded the ACSQHC for taking the lead in developing the standard, which it described as “robust”, aside from the two matters it disagreed with.

“The broad range of stakeholder engagement has resulted in a comprehensive set of standards. RANZCO was represented by an ophthalmologist in the working group, and there were a number of ophthalmologists representing different parts of the sector,” Verma said.

However, based on the advice of its representative and after further extensive discussion and correspondence with ACSQHC, he said RANZCO decided not to endorse the standard.

“In particular, our concern regarding Snellen acuity as a prioritisation factor for cataract surgery does not align with any international standard,” Verma said.

“The survey of the [RANZCO] fellowship earlier this year showed that over 80% of the respondents advised that a correct acuity of 6/12 is not the most important determinant for surgical intervention for cataract patients, while 54% dismissed Snellen acuity as an appropriate measure to prioritise patients for surgery.”

Further, he said RANZCO “strongly disagreed” with the need to routinely discuss same or following day second-eye surgery.

Around 96% of respondents to the fellowship survey do not provide such a service.

“A similar percentile have views that same day sequential cataract surgery should not be offered as a routine alternative to surgery performed on separate days,” Verma said.

The college also shared with members it felt there is a “real risk” that some ophthalmologists will apply 6/12 visual acuity as a measure for cataract, and the recommendation to offer all patients bilateral same day surgery, in isolation and not consider all factors that go into making a decision about cataract surgery.

“We remain disappointed that the ACSQHC have not listened to the experts when making a final decision about the standards, as apart from these issues, they are very robust,” Verma said.

He said RANZCO supported its fellows being the best placed to make a recommendation to their patients about why and how cataract surgery should be performed.

“We strongly resist parts of the standards being used in isolation by hospitals or private health insurers to determine funding for cataract patients.”

More ‘appropriate and efficient’ treatment 

In a media release announcing the launch, the ACSQHC said it would help to define clear pathways of care so that decisions about cataract surgery were more consistent nationally and based on clinical need.

Conjoint Professor Anne Duggan, commission chief medical officer, said the new standard would ensure cataract treatment was appropriate and more efficient, with patients who are more likely to benefit from surgery being clearly identified.

“With increasing demand for cataract surgery due to improved surgical methods and an ageing population, it’s never been more important to ensure that we have the right care pathways,” she said.

“We need to ensure that cataract patients are prioritised for surgery or non-surgical alternatives based on both clinical need and individual circumstances. An additional benefit will be reduced public hospital waiting times.”

During the COVID pandemic, the necessary suspension of non-urgent elective surgery in some states and territories has delayed cataract surgeries, and led to growing waiting lists.

“While the standard was in development before the pandemic, COVID has increased the need for us to work together across the healthcare system to manage prioritisation for cataract surgery, with the common goal of improving the efficiency, effectiveness and equity of care,” Duggan said.

The new standard can be accessed online from Tuesday 17 August at safetyandquality.gov.au/cataract-ccs.

More reading

A black and white case? Snellen acuity and cataract surgery

Survey provides insight into Australian cataract surgery landscape


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