Investigating target refraction advice provided to cataract surgery patients by UK optometrists and ophthalmologists

Abstract

To determine whether UK optometrists and ophthalmologists provide target refraction advice to patients prior to cataract surgery, and when this should first be discussed.Methods: Optometrists and ophthalmologists were asked to complete a survey of two clinical vignettes (both older patients with cataract; a pre-operative myope who routinely read without glasses and a patient using a monovision approach), plus multiple choice and short answer questions either using hard copy or online. Results:Responses were obtained from 437 optometrists and 50 ophthalmologists. Optometrists who reported they would provide target refraction advice were more experienced (median 22 years) than those who would leave this to the Hospital Eye Service (median 10 years). The former group reported it was in the patients' best interest to make an informed decision as they had seen many myopic patients who read uncorrected pre-operatively, and were unhappy that they could no longer do so after surgery. Inexperienced optometrists reported that they did not want to overstep their authority and left the decision to the ophthalmologist.The ophthalmologists estimated their percentage of emmetropic target refractions over the last year to have been 90%. Conclusion:Currently, some long-term myopes become dissatisfied after cataract surgery due to an emmetropic target refraction that leaves them unable to read without glasses as they did prior to surgery. Although experienced optometrists are aware of this and attempt to discuss this issue with patients, less experienced optometrists tend not to. This suggests that target refraction needs greater exposure in university training and continuing professional development. To provide patients with the knowledge to make informed decisions regarding their surgery, we suggest an agreed protocol within funded direct referral schemes of initial target refraction discussions by optometrists to introduce the idea of refractive outcomes and outline options, with further discussion with the ophthalmologist to clarify understanding.

Distance spectacle‐wearing habits in older patients in England

“…Among bilateral pseudophakes, full‐time DV wear was 37% (15/41), with 17% (7/41) wearing part time (average 60%) and 10% (4/41) rarely so that 54% of bilateral pseudophakes wore DV correction all or most of the time and 63% some or all of the time. The degree of DV correction wear is surprisingly high considering the target of approximately 90% of cataract surgery in England is emmetropia 27 and, by extension, distance spectacle independence. However, these figures are similar to previous findings from England (52%), 5 the Netherlands (65%) 8 and Sweden (49%) 9 but larger than a report from the US (40%) 10 and more than double that from another English study (23%) 7 .…”

Developing refractive management recommendations for patients undergoing cataract surgery: A Delphi study

“…They support optometrists playing a role in the provision of information regarding target refraction and postoperative refractive management of patients with cataract. Implementing these recommendations in practice could both remediate areas of concern for patients, 2 help optometrists with their clinical decisions and discussions and may be of particular benefit to less experienced optometrists 3 . Joint refractive management by optometrists and ophthalmologists could provide high‐quality and convenient patient care if agreed protocols and appropriate training and remuneration were provided.…”

“…The initial list of 18 recommendations (Figure 1) was developed by two optometrists (EC and DBE, 4 and 31 years of experience, respectively) and one highly experienced cataract surgeon (PU, president-elect of the United Kingdom and Ireland Society of Cataract and Refractive Surgeons) and modified with the input from LK (highly experienced Australian optometrist, public health epidemiologist and researcher) and KCH (Hong Kong optometrist and researcher in cataract service provision). This initial list targeted areas of concern raised by patient focus groups 2 and was evidence-based 9 and integrated clinical expertise from optometry and ophthalmology with the best available clinical evidence from the research literature [1][2][3][4][5]7,[10][11][12][13][14][15][16][17][18][19][20][21][22] including relevant sections from currently published guidelines from the UK National Institute for Health and Care Excellence (NICE) 18 and the Royal College of Ophthalmologists 1 (although these did not cover all of the areas of concern highlighted by patients). 2 Recommendations were split into four categories: organisation (one item); target refraction (six items); refractive management of patients postoperatively (eight items) and driving advice following surgery (three items).…”

“…Within the UK, approximately 400,000 cataract surgeries are performed per year, with this figure anticipated to increase by 50% in 2035. 1 Investigating patient experiences of cataract surgery has highlighted several refractive management challenges faced by both patients and practitioners in the preoperative and postoperative period, 2 , 3 but there are no UK optometric guidelines regarding best practice refractive management for cataract surgery patients.…”

“… 2 Barriers to practitioners discussing target refraction with patients included practitioner inexperience and consultation time limitations. Optometrists with little experience were shown to be less likely to discuss target refraction when referring patients for surgery due to a lack of confidence and knowledge, 3 suggesting that inexperienced optometrists would benefit from guidance in these clinical discussions.…”