Editor,—Allan and co-authors raised an interesting question in their recent suggestion that alternatives to conventional postoperative care, including shared care with non-ophthalmologists, should be evaluated.1 Previous studies looking at this issue have been contradictory. A study by the American Office of Technology looked at the differences in education and training between optometrists and ophthalmologists and concluded that the co-management of postoperative cataract patients may carry “potential risks”.2 In contrast, a large retrospective review of over 2000 co-managed patients concluded that co-managed postoperative care with optometrists “can be successfully organised, coordinated and delivered”.3 Similar suggestions have been made by other authors.4 5

In 1994 we carried out a prospective study to determine whether the postoperative management of cataract patients by optometrists is a safe and viable option. The optometrists involved in the study were a selected group who were not only already participating in our local glaucoma monitoring scheme, but also received education, by ourselves, on the care of postoperative cataract patients. In all, 121 patients, who had undergone uncomplicated extracapsular cataract extraction or phacoemulsification, were examined at 6 weeks postoperatively by an optometrist who performed both a refraction and a full ocular examination, following a strict examination protocol. A telephone “hotline” was available for the optometrist to seek advice if any abnormality was found. The patients were then examined by an ophthalmologist following the same examination protocol. The findings of the optometrist and ophthalmologist were compared. There was a high degree of consistency between the examination findings of the two groups, with only minor discrepancies in a few patients over the degree of posterior capsule thickening and age related macular degeneration. Most importantly, there were no clinically significant abnormalities missed by the optometrists. We therefore felt that, in our region, it was both safe and feasible for optometrists to carry out the postoperative management of uncomplicated postoperative cataract patients.

Since this initial study, we have routinely involved optometrists in the postoperative care of cataract patients. A recent audit confirmed the safety and feasibility of the practice. Patients welcome the opportunity to visit an optometrist for their postoperative care, citing improved access and convenience as major advantages. The benefits stemming from a reduction in our routine outpatient workload are obvious.