Cataracts  

Pre-Cataract assessment: 

An appointment designed to confirm the following:

1. The patient has a visually significant/symptomatic cataract

2. The patient would like to have an onward referral for cataract surgery 

A pre-cataract assessment should include the following:

1. Comprehensive H&S including.

   1. Occupation status 

   2. Driver (Y/N)

   3. Lives alone (Y/N)

   4. Locally registered GP practice 

   5. Symptoms/effects on quality of life 

   6. Whether the patient has any accessible need information (e.g., wheelchair access needed)

2. An up-to-date refraction and visual acuities

3. Dilated examination of anterior and posterior eye health

4. IOP readings 

5. Note of any co-morbidities 

6. Note of surgical refractive target 

7. Where the patient would like to be referred to and for which eye(s)

8. Explanation of the risks/benefits of cataract surgery to the patient 

   1. The patient must also be given literature on cataract surgery and local pathways 

Referral considerations:

• NHS referral criteria are currently 6/12 in the worst eye, or symptoms that are significantly affecting the quality of life. In the case of ambiguous VA, note symptoms carefully such as glare, monocular diplopia, quality of life, etc. 

• In line with NICE guidance, do not restrict access to cataract surgery based on visual acuity.

• When referring patients with comorbidities (advanced Glaucoma/ Wet AMD), the optometrist should be able to demonstrate how cataract surgery is likely to improve the visual function. 

• The cataract must be affecting quality of life and ability to undertake everyday tasks. 

• The patient must want to have surgery if offered. Do not refer if the patient does not want to have surgery.