## National Ophthalmology Database Audit Key Findings Summary 2018

The NOD audit illustrates 30% reduction in PCR complications in cataract surgery since 2010. This equates to around 2,500 less complications annually. In 2010, the overall unadjusted PCR rate was 2.0% (unchanged from pre-2006) and in the most recent year this has reduced to 1.4%.  
Cataract surgery is the most frequently undertaken NHS surgical procedure with approximately 400,000 cataract operations undertaken in England and 20,000 in Wales in the 2016 - 2017 NHS year. This report is a snapshot of cataract surgery quality from 83 NHS funded centres in England and Wales. Two primary indicators of surgical quality are audited. 

1.	
The term **Posterior Capsular Rupture or Vitreous Loss or Both (PCR)** refers to a breach of the 
normal barrier between the front and back parts of the eye. PCR can arise as a complication of cataract surgery and may allow vitreous (a transparent substance with the consistency of egg-white which occupies the space inside the eye behind the lens) to move forward into the front part of the eye. When PCR occurs, it increases the risk of loss of vision after surgery.
2.	
Visual Acuity (VA) Loss (visual harm related to surgery): for cataract surgery, the most important 
outcome is vision; this is what matters most to patients. Vision which is worse after the operation than before is identified as an adverse outcome.
This is the second prospective national annual report and includes data on 183,812 eligible cataract operations for the period 01 September 2016 to 31 August 2017, from 148,785 patients.

## Key Findings First Treated Eye Cataract Surgery 110,228 (60%)

27,610 (25%)
having diabetes mellitus 
1,073 (1%)
1,335 (1.2%)

## Second Treated Eye Cataract Surgery Recommendations 1. Recommendations For Patients

 
1.1  Information has been made 
easily accessible to the general 
public
1.1.1  Patients, carers and those 
with an interest in cataract surgery are encouraged to access and view data regarding their local services. Information about the quality of cataract surgery can be viewed online on the National Ophthalmology Audit Database 
website and the HQIP website. In 
addition, data can be accessed on the NHS Choices website

## 2. Recommendations For Providers Of Contract Surgery

2.1  Publicly promote your 
commitment to fostering good professional practice by involvement in the audit 

## 

2.2  Support the improved use of 
electronic data collection and data completeness in your organisation, enable staff to implement change. Complete data helps ensure all relevant factors such as case complexity are submitted to the audit and can be included in the NOD analysis
2.3  Identify specific areas that 
need improvement by comparing your results against past performance 
3.1  Use your audit outcomes 
report in appraisal discussions

## 3. Recommendations For Surgeons

3.2  Identify specific 
opportunities for improvement by comparing your results against peers and your own past performance 
1.1.2  Patients should ensure they 
discuss and understand the risks 
and outcomes of any eye surgery with their consultant
1.1.3  Information on cataract 
surgery is available from hospital trusts and Health Boards. Further information about cataracts can also be obtained from the charity organisations such as RNIB (Royal National Institute of Blind) 
2.4  Promote use of the 
audit information in medical revalidation and appraisal 
2.5  Encourage use of the EMR 
audit tools for continuous monitoring of results for early detection and correction of possible increases in adverse event rates
2.6  Care providers should 
review their patient pathways to maximise the recording of both preoperative and postoperative VA data for every operation
3.3  Use the EMR audit tools for 
continuous monitoring of your results for early detection and correction of possible increases in adverse event rates

## Recommendations 4. Recommendations For Commissioners

4.1  An increase of around 50% in 
cataract operations is predicted over the next 20 years (25% 
increase over the next 10 years - RCOphth Way Forward), plan services appropriately using NOD and other data
4.2  Check the 2017 NICE 
guidelines on cataract surgery (recommendations for commissioners 1.9)
4.3  Include submission of data 
to the NOD as a lever of quality in supplier contracts

## 5. Recommendations For The Regulator

5.1  When inspecting NHS 
organisations, information regarding national audit commissioning, participation and performance should be routinely requested from commissioners and providers of cataract care
5.1.1  Regulators should expect 
participation in national audits with audit results made available 

## Next Steps

•	The audit will extend coverage to include more 
centres in the next audit period, 01 September 2017 - 31 August 2018. Currently 111 of 122 traditional NHS cataract providers and two independent sector providers have indicated that they wish to participate in the audit going forward
The full annual report is available on the NOD audit website  www.nodaudit.org.uk/resources/publications-annual-report National Ophthalmology Database Audit The Royal College of Ophthalmologists 18 Stephenson Way, London NW1 2HD
T. 020 7935 0702 noa.project@rcophth.ac.uk nodaudit.org.uk  

4.4  Establish quality focused 
contracts with providers which include requirements for reporting 
of National Audit based outcomes
4.5  Establish contracts with 
community services which require return of postoperative VA and refractive data back to the surgical provider through use of the audit tools
to them when inspecting NHS organisations
5.1.2  All providers of care should 
be expected to be in a position to provide quality assurance regardless of whether they are traditional NHS centres or independent providers

•	The audit is piloting the feasibility of collection 
of PROM (patient reported outcome) data to improve understanding of the impact of cataract surgery on patients