A patient with visual problems due to suspected cataract requires an ocular examination, preferably performed using a slit lamp biomicroscope or direct ophthalmoscope, and an assessment of how their visual problems are affecting their life. Optometry referral may be a suitable initial option for assessment of cataract.
Discuss the possible options to manage the patient’s symptoms and advise them that the presence of cataract alone is not an indication for surgery. Patients with lens opacities that do not cause visual symptoms or limit daily activities can continue to be managed and monitored in the primary care setting.
Consider referral for possible cataract surgery when patients have visual impairment that interferes with their ability to carry out their usual daily tasks, considering the possible impact on their ability to live independently. Ocular or medical comorbidities may affect the urgency of referral. Visual impairment can include reduced visual acuity, or disabling glare or contrast sensitivity. Vision-related activity limitations may include a loss of ability to work, drive, carry out daily tasks, or care for themselves or others – for example, an increased risk of falls in older people with risk factors. Box 1 provides information about assessment of vision-related activity limitation and some examples of assessment tools, see Cataract Clinical Care Standard full document.
Discuss the potential benefits and harms of cataract surgery, including the disadvantages of poor vision and the risks of complications. Assess the patient’s willingness to proceed with surgery if it is offered. Ophthalmology assessment can confirm whether patients with ocular comorbidity are more likely to benefit from surgery, or have an increased risk of complications.7
If referral is appropriate, check the referral criteria for the receiving service you are referring to, because requirements may differ between services. Ensure that all required information is provided; use a standardised cataract referral template if one is available. Both general practice and optometry assessment may be needed to provide the information required.43-46 Improving the quality of the referral46 can reduce delays for patients by helping ophthalmology services triage access to ophthalmology services and assess medical suitability for surgery.42,47 Elements of a comprehensive referral that may be required by local referral guidelines are listed in Box 2, see Cataract Clinical Care Standard full document
If the patient does not to want to consider cataract surgery and there are no other indications for ophthalmology assessment, referral to an ophthalmology service may not be appropriate. Provide support for patients to reduce the impact of their visual problems, including refractive correction, tinted lenses to reduce glare, or use of suitable equipment to optimise vision and improve the patient’s capacity for activities of daily living.7 Refer to an optometrist, orthoptist, occupational therapist or vision clinic or other provider of low-vision services, if appropriate.