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Cataracts – Information for GPs

Background

NHS Scarborough and Ryedale CCG commissions’ healthcare on behalf of its local population across primary, secondary and tertiary care sectors. Commissioning policy including clinical referral pathways and thresholds have been developed and defined using appropriate NICE guidance and other peer reviewed evidence and are summarised here in order to guide and inform referrers.

This policy defines the SCRCCG commissioning position for cataract surgery.

Commissioning position

Referral should not be made simply on the presence of a cataract but will need to demonstrate that that the patient’s condition in terms of visual acuity and impact on lifestyle/activities of daily living exceeds the commissioning threshold for referral.

The referral template for cataract is attached and should be used for all referrals from accredited Optometrists and GPs (where no accredited Optometrist service is available).

Link to the direct cataract form is here.

The referral should also confirm that the patient is willing to undergo cataract surgery.

The referring Optometrist or GP should discuss the risks and benefits using an approved information leaflet (e.g. Royal College of Ophthalmologist’s leaflet ‘Understanding Cataracts’) and ensure that the patient understands and is willing to undergo surgery before referring.

Second Eye

As the benefits of second eye surgery have been demonstrated patients will be offered second eye surgery provided they fulfil the referral criteria. Second eye surgery should be deemed urgent when there is resultant anisometropia (a large refractive difference between the two eyes of 2 ½ dioptres) which would result in poor binocular vision or diplopia (this should be clearly recorded in the patient’s notes).

The reasons why the patient’s vision and lifestyle are adversely affected by cataract and the likely benefit from surgery must be documented in the clinical record.

Providers may be audited on the indications for cataract surgery.

Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes exceptional circumstances exist that warrant deviation from the rule of this policy. Individual cases will be reviewed as per the CCG policy.

Patients are able to self-present to a participating optometrist

A list of participating optometrists can be found by clicking here.

Information to include in referral letter

  • Details of how the patient meets the above criteria OR demonstrates clinical exceptionality
  • Impact on activities of daily living
  • Drug history (prescribed and non-prescribed)
  • Relevant past medical/surgical history
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption

Summary of evidence/rationale

NICE Clinical Knowledge Summary: Cataracts (July 2013)

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