Cataract

The following information is intended as guidance for Optometrists and GPs considering referral for possible cataract surgery:

Please ensure a formally documented shared decision-making process has been performed with the patient (and their family members or carers, as appropriate). This includes but is not limited to:

• How the cataract affects the persons vision and quality of life
• Whether one or both eyes are affected
• What cataract surgery involves, including possible risks and benefits
• Whether the patient would accept surgery
• How their quality of life may be affected if they choose not to have surgery

Please see this decision support tool, available to aid patient discussion.

 

Indications for Referral

• Best corrected visual acuity of 6/12 or worse in the affected eye – include details of this in referral letter
• Does the patient have significant visual symptoms from their cataract that removing it would improve their quality of life?
  • Difficulty in carrying out employment duties
  • Experiencing significant glare due to cataracts when driving at night
  • With visual field defects borderline for driving (in whom cataract extraction would be expected to significantly improve the visual field)
  • With posterior subcapsular cataracts and those with cortical cataracts who experience problems with glare and a reduction in acuity in bright conditions
  • Difficulty with reading, or recognising faces due to lens opacities
  • With significant optical imbalance (anisometropia or aniseikonia) following cataract surgery on the first eye
  • With glaucoma who require cataract surgery to control intra ocular pressure
  • With diabetes who require clear views of the retina
  • With wet macular degeneration or other retinal conditions who require clear views of their retina to monitor their disease or treatment (E.G treatment with anti-VEGFs)
     

NB: Difficulty with near tasks are less likely to be due to cataract and more likely to be macular disease.

 

Optometry and Primary Care Management Prior to Referral

• An Optometry report within the last 6 months must be attached
• An up-to-date medication list is required
• Establish if the patient has existing/suspected other eye pathology

Please note the reasons why the patient’s vision and lifestyle are adversely affected by cataracts and the likely benefits the patient would gain from having surgery, or any other exceptional circumstances, must be clearly documented in the clinical records.

 

Where to Refer

Refer to the RMS using the NHS Kernow assessment service on eRS.  The RMS will then refer on as appropriate:

• If optometrist report included and there is no suggestion of significant other pathology:
  • RCHT One stop assessment clinic
  • Probus Surgical Centre one stop see-and-treat service
• If the patient has significant other eye pathology and/or are under the care of an Ophthalmologist at RCHT they should be sent to the general Ophthalmology clinic RCHT.

 

NB Cataract surgery carries a 1:1000 risk of loss of vision.

 

Useful Resources

Patient

• NHS eye sight test eligibility and vouchers

Professional

• NHS England » Decision support tool: making a decision about cataracts

 

 

Page Review Information

Partial Update         06 May 2025

Next review due      06 May 2026

Sifter name             Dr Rebecca Harling

Contributor              Mr William Westlake

                               Dr Kate Northridge