Please see the Lothian cataract referral guidelines flowchart
Thank you for your help in improving the efficiency of cataract surgery referrals. Our aim with these guidelines is to encourage referrals for patients in greatest need of surgery in order to preserve limited NHS resources.
1. All patients should have assessment by an Optometrist prior to referral
- This is vital because some patients can improve their visual acuity simply by a change of the prescription in their glasses. If you are a GP and suspect a cataract please complete this form for patients to take to their optometrist
- The Optometrist provides essential visual acuities for near and distance both with and without glasses/contact lenses. This information is needed to determine the power of the intraocular lens implant, should there be a decision to proceed with cataract surgery. Please also note the degree of cataract present (i.e. not clinically significant, mild, moderate or severe) and any macular changes that could compromise the outcome of cataract surgery.
- We would be grateful if all patients referred for cataract surgery be accompanied by the new cataract assessment form from their Optometrist (OPT003)
- When the GP practice receives the above form back from the Optometrist, simply scan this into Docman, then attach to a SCI Gateway referral which can be found in the Gateway ‘tree’ as:
PAEP)/St John’s > Opthalmology – Cataract > LI Cataract. It is not necessary for the GP to see the patient as the optometrist will have checked the need for referral and whether the patient is amenable to surgery.
2. Please refer only patients with functional impairment of vision
- A brief assessment of the patients’ visual requirements for day to day activities for living (visual function) is important to decide whether referral is necessary to attend the optometrist and then the Eye Clinic. Patients should only be referred if their vision from cataracts sufficiently impairs their way of life (e.g. watching television, reading, driving and pursuit of sports, hobbies or employment).
3. Please refer only patients if they are in principle keen to have surgery
- The visual acuity level alone is not the sole criteria for cataract surgery because all surgical interventions carry a risk of complications. Patients need to be provided with realistic expectations to avoid disappointment and patients with pre-existing good visual acuities often have the highest expectations. There is a small but ever-present risk of total blindness from cataract surgery and as such patients should only be referred for cataract surgery if they have impaired visual function and are keen, in principle, to have cataract surgery.
- The optometrist assessment will include in their referral the type of functional impairment and whether patients are keen for surgery.
4. Refractive Outcomes
- Following surgery patients will be given an outcome reporting form and asked to see their optometrist 4-6 weeks following surgery. Optometrists should complete the form with the new refraction and send it to the eye Pavilion/St John’s detailing whether the patient wishes to go ahead with further surgery. Return of this form is essential to allow us to audit our refractive outcomes, our complication rates and to ensure the patient is listed for their second eye.
