Cataract is an opacity of the lens of the eye causing visual impairment.

Causes/risk factors

• Increasing age
• Diabetes
• Hypertension
• Obesity
• Smoking
• High myopia
• Previous eye surgery
• Congenital

Signs and Symptoms

• Blurred vision
• Reduced vision
• Glare
• Reduced colour intensity
• Monocular diplopia

Examination

• Fundoscopy
• Red reflex

Visual acuity

• Sudden change in vision
• Eye pain
• Red eye
• Visual field defect

Symptoms can often be helped by updating glasses/contact lens prescription

Control unwanted glare

Cataract surgery may be appropriate when patients fulfil the NHS Devon commissioning policy criteria

Pre-referral Criteria for Adult Cataract Surgery

Before a referral is made the referrer must confirm that:

• The patient understands that the purpose of the referral is for assessment for surgery
• The patient wishes to have surgery if it is offered
• The patient meets the criteria for cataract surgery

Referral Criteria

Cataract surgery is only routinely commissioned in the following circumstances:

There is sufficient cataract in the eye proposed for surgery to account for the patient’s visual symptoms AND one or more of the following due to subjective loss of visual performance:

• Best corrected visual acuity of 6/12 or worse in affected eye AND patient experiences one or more of the following:
  • Difficulty accomplishing everyday tasks
  • Reduced mobility, visual problems when driving or experiencing difficulty with steps or uneven ground
  • Ability to work, act as a carer or live independently is affected
• Patients who experience disabling problems with glare and a reduction in acuity in daylight or bright conditions or reduced contrast sensitivity
• The patient has a best corrected visual acuity of better than 6/12 in the affected eye but they are working in an occupation in which visual acuity of better than 6/12 is essential to their ability to continue to work
• Where there is anisometropia following cataract surgery with a refractive difference between the two eyes of at least +/- 2.0 dioptres resulting in poor binocular vision or diplopia
• Patients with rapidly progressive myopia (shift of more than -0.75 dioptres within a 6-month period)

NB As a cataract becomes denser it changes the refraction of the eye, making it more myopic. Most cataracts cause some myopic progression and the speed of which this occurs determines whether it is rapid or not. A shift of more than -0.75 dioptres within a 6-month period is the measurement of rapid progression.

Cataract surgery is also routinely commissioned under the following circumstances:

• Patients with glaucoma who require cataract surgery to control intra-ocular pressure
• Patients with glaucoma who have undergone a trabeculectomy
• Patients who have undergone a vitrectomy
• Patients with diabetes in whom removal of the cataract is necessary to facilitate effective screening for diabetic retinopathy

See DVLA guide to the medical standards for fitness to drive

Referrals submitted that do not met the policy criteria will be returned.

Referral Instructions

e-Referral Service selection:
Specialty: Ophthalmology
Clinic Type: Cataract
Service: DRSS-Northern-Ophthalmology- Devon ICB- 15N

Referral Forms

GP referral form

Opticians referral form

Patient Information

MyHealth patient information - Cataracts

Making a decision about Cataracts

Pathway Group

This guideline has been signed off on behalf of NHS Devon

Publication date: 19 October 2015

Updated: January 2023