title: Evaluation of clinical threshold policies for cataract surgery among English commissioners.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Primary Care and Public Health, Imperial College, London. s.coronini-cronberg@imperial.ac.uk
authors.forename: Sophie
authors.initials: S
authors.lastname: Coronini-Cronberg
authors.forename: Henry
authors.initials: H
authors.lastname: Lee
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: Peter
authors.initials: P
authors.lastname: Smith
mesh_terms: D002387:Cataract Extraction; D004739:England; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D016134:Organizational Policy; D018579:Patient Selection; D011320:Primary Health Care / Q000458:organization & administration*; D013222:State Medicine