Purpose: To develop a selection pathway to facilitate the use of multifocal intraocular lenses (mfIOLs) in cataract surgery in a public hospital setting.
Methods: A single-surgeon prospective cohort study in an Australian tertiary referral public hospital was conducted. A mfIOL selection pathway was designed and assessed. Outcomes measured included unaided distance (UDVA), intermediate (UIVA) and near visual acuity (UNVA), dysphotopsia, spectacle dependence and satisfaction. Patient-reported outcome measures (PROMs) were assessed using Catquest-9SF (CQ) and Near Visual Acuity Questionnaire (NAVQ). A cost-analysis was performed.
Results: Fifty-four eyes from 27 patients underwent cataract surgery with mfIOL implantation. The monocular UDVA (mean ± standard deviation) was 0.05 ± 0.12 logMAR; UIVA 0.19 ± 0.05 logMAR; UNVA 0.28 ± 0.14 logMAR; 87% and 98% of eyes achieved within 0.5D and 1.0D of target refraction respectively. Spectacle independence was 85% at distance, 81% at intermediate, 59% at near vision. High satisfaction was reported with CQ (>85%) and NAVQ (100%). The cost difference between bilateral monofocal and mfIOLs is comparable to a pair of spectacles. Projected annual cost to the health system for a 5%-10% eligibility rate is 1.1-2.3 million Australian dollars.
Conclusion: The selection pathway presented overcomes the challenges in patient selection inherent to a public hospital setting and was implemented by a senior trainee with excellent vision and PROMs. The pathway ensures the cost-effectiveness of mfOL implantation. There are several funding models that can be applied to support equitable access and improved visual outcomes with mfIOLs within the government funded health system.
Keywords: cost analysis; multifocal IOL; satisfaction; selection pathway; visual outcomes.
Cataract surgery is a safe and effective procedure that is performed in both the private and public sectors. Traditional intraocular lenses offer clear vision at one distance, meaning that spectacles are required post-surgery. Advances in lens technology now offer the possibility of multifocality, that is, clear vision at two or more distances and the possibility to remain spectacle free. These multifocal intraocular lenses (mfIOLs) are not readily available in the public sector, due to the complexity of patient selection and of trainee experience with the mfIOLs. In this study, conducted at Westmead Hospital in Sydney, Australia, researchers aimed to develop a pathway for patient selection for mfIOLs. The study evaluated outcomes including the resultant visual acuity, the experience of visual disturbances, dependence on glasses and patient satisfaction. They also performed a cost analysis. The results showed that the pathway was successful and that most patients achieved excellent visual outcomes with mfIOLs, with high satisfaction rates reported. Around 85% were able to see well without glasses at a distance, 81% at intermediate distances, and 59% at near distances. The additional cost of mfIOLs was found to be comparable to the cost of glasses over time, making them a cost-effective option. In conclusion, the study demonstrated that the selection pathway effectively addressed challenges in choosing patients for mfIOLs in public hospitals, which can facilitate access to mfIOLs for public patients.
© 2024 Sartor et al.