The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 20, the hidden cost of intraocular lens choices for National Health Service funded cataract surgery in England

Background Patients that have a hydrophilic intraocular lens (IOL) inserted during cataract surgery are more likely to develop posterior capsular opacification (PCO) and require YAG laser posterior capsulotomy than those with hydrophobic IOLs. This study aimed to examine the cost implications of hydrophilic and hydrophobic IOL usage in NHS-funded cataract services in England and estimate the cost saving of increased hydrophobic IOL usage. Methods The cost of IOLs and YAG laser posterior capsulotomy was determined using NHS Spend Comparison Service data and Payment by Results tariffs. Data from the National Ophthalmology Database (NOD) audit was used to estimate PCO rates and the proportion of cataract cases that used hydrophilic and hydrophobic IOLs in England during the 2022 NHS year. Results The cumulative cost per case of purchasing an IOL and YAG laser posterior capsulotomy treatment over the 9-year period following cataract surgery was £148.73 (£96.83–£199.12) for hydrophilic IOLs and £107.58 (£62.99–£150.05) for hydrophobic IOLs. Of the cataract cases performed in England during the 2022 NHS year that were reported to the NOD, 52% used hydrophilic IOLs and 46% used hydrophobic IOLs. If all cases that used hydrophilic IOLs in England during the 2022 NHS year had instead used hydrophobic IOLs, the reduced need for YAG laser posterior capsulotomies could have saved around £13.0 million (£10.7 million–£15.6 million). Conclusions Hydrophilic IOLs remain popular amongst NHS-funded cataract services in England. Increasing hydrophobic IOL usage could be an effective strategy for lowering PCO rates while generating recurrent annual financial savings.

Citation

Malcolm, J., Donachie, P. H. J., Hernández, R., et al. (2025). The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: Report 20, the hidden cost of intraocular lens choices for National Health Service funded cataract surgery in England. Eye. Advance online publication. https://doi.org/10.1038/s41433-025-04033-4

DOI

10.1038/s41433-025-04033-4

URI

https://hdl.handle.net/20.500.14709/1080