Evaluation of clinical threshold policies for cataract surgery among English commissioners

Objectives: To ascertain if access to cataract surgery is being restricted in England and to describe any explicit threshold criteria. Methods: A survey of 151 local commissioners to explore their cataract surgery policy. A literature review identified research evidence about thresholds for cataract surgery. A checklist was devised and applied to the policies supplied by commissioners. Results: Almost half (71/151) of commissioners were restricting access to surgery and this included patients with some capacity to benefit. There was wide variation in the scope and content of the 67 policies which were available for review. Almost all (92%) commissioners use criteria that do not reflect guidance or research evidence. Conclusions: Patients who could benefit from cataract surgery are being excluded by some commissioners. Variations in policy between commissioners results in inequalities in access. Journal of Health Services Research & Policy Vol 17 No 4, 2012: 241-247 (C) The Royal Society of Medicine Press Ltd 2012