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Assessing the budget impact of toric lens surgery in the NHS

A toric lens is a type of intraocular contact lens (IOL) that can be implanted during cataract surgery to improve long distance vision and correct astigmatism, reducing a patient’s reliance on glasses. HEU was approached by J&J Vision to assess the budget impact of introducing Toric lens surgery for NHS patients with pre-existing astigmatism who are being treated for cataracts.


Real-world studies of cataract surgery by the NHS indicate that the majority of surgeries use monofocal IOLs, which are not effective in correcting astigmatism. Despite NICE recommending surgical procedures for patients with astigmatism, the data suggests that astigmatism correction procedures are very rarely used in practice. Toric lenses are used privately in the UK, but real-world NHS use of toric lenses has typically focused on patients with higher degrees of astigmatism.

J&J Vision asked HEU to create a budget impact model to help them decide whether further studies and evidence generation could potentially lead to a case for implementing toric lens surgery more widely within the NHS.

What we did

Using publicly available real-world data, literature reviews and gathering clinical expert opinion from three clinicians at Moorfield’s Eye Hospital and one community optometrist, we assessed the budget impact across the whole patient pathway. This included estimating the eligible population size and all additional costs associated with using a toric lens – equipment costs, the cost of cataract surgery (including the lens itself), and any additional surgery or appointments needed.

The NHS currently funds optical vouchers for certain groups of people which help reduce the cost of buying glasses. Part of the study was to assess if the additional costs of using toric lenses could be offset by a saving from fewer patients needing to redeem optical vouchers.


Surgeons in our network estimated that fewer surgeries could be performed per day with toric lenses, increasing surgery costs, and that additional hospital appointments would be required.

Ultimately, the study found that the NHS optical vouchers are relatively low cost and not widely used. As such, using toric lenses would not have a large enough impact to offset the additional costs.

However, non-cost benefits are not captured in a budget impact analysis and other considerations (for example, increased quality of life due to freedom from distance glasses) formed the core of the argument for establishing a toric lens pathway at Moorfield’s Eye Hospital.

With that in mind, the next phase of this project will involve looking more closely at the potential wider health system value of toric lenses.

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