Cataract Surgery – Criteria Led Commissioning Statement

Scope

This commissioning statement refers to:

  • The elective eye surgery for the treatment of cataracts in adults

This commissioning statement does not refer to:

  • URGENT referrals via existing diabetic retinal screening pathway

Status

Eligibility Criteria

The National Institute for Health and Care Excellence (NICE) provides national guidance, advice and standards to improve health and social care services. NICE recommends that access to cataract surgery should NOT be restricted on the sole basis of visual acuity. Referrals shall instead be determined on assessment of visual acuity and the impact on the patient's life and discussion with the patient at the referral point for cataract surgery.

The decision to refer a person with a cataract for surgery should be based on a discussion with them (and their family members or carers, as appropriate) that includes:

  • how the cataract affects the person's vision and quality of life
  • whether 1 or both eyes are affected
  • what cataract surgery involves, including possible risks and benefits
  • how the person's quality of life may be affected if they choose not to have cataract surgery
  • whether the person wants to have cataract surgery

Before a referral is made, the referrer must confirm that:

  • The patient understands that the purpose of referral is for assessment for surgery. The patient wishes to have surgery if it is offered.
  • The patient meets the criteria for cataract surgery.
  • At referral for cataract surgery, patients must receive information about:
    • what cataracts are
    • how they can affect vision
    • how they can affect quality of life
  • Patient's should also receive information on cataract surgery including:
    • what it involves and how long it takes
    • possible risks and benefits
    • what support might be needed after surgery
    • likely recovery time
    • likely long-term outcomes, including the possibility that people might need spectacles for some tasks
    • how vision and quality of life may be affected without surgery.
  • When referring patients for cataract surgery Optometrists must refer the first and second eye separately. The rational for this is where patients have a higher refractive error in both eyes and the operated eye is corrected to a very small refraction, a large imbalance can exist. Where this is clearly the situation the patient should attend a post-operative assessment with an Optometrist so that patients can:

i) Make a choice as to whether they wish to proceed with the second eye
ii) Decide if they wish to return to the first provider or potentially go elsewhere.

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.

Referrers will be required to complete a pre Cataract referral form to determine the patients suitability for surgery in line with this commissioning statement and NICE guidelines.

Evidence/Rationale

References

Assurance & Governance

  • This policy was updated on: 05.2018
  • This policy was approved by: Clinical Strategy Group (NK) and Clinical Cabinet (WK)
  • Date approved: 07.2018
  • Publication Date: 07.2018
  • Review Date: 04.2019
  • Ref No: PA16 - 05.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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