Cataract Surgery (Surgery to remove cloudy lens in the eye)

Eligibility criteria for provision of the intervention

Where a cataract has been identified, the decision to refer and treat a person should be based initially on a discussion with them (and their family or carers, as appropriate) that includes:

• How the cataract affects their vision and quality of life.
• Whether one or both eyes are affected.
• What surgery involves, including the risks and benefits, likely recovery time, and long-term outcomes, including the possibility that people might need spectacles for some tasks. Appropriate information leaflets should be provided to the patient.
• How their quality of life may be affected if they choose not to have surgery.
• Whether they want to have surgery.

The potential to benefit from cataract surgery depends on a number of factors including the patient’s visual acuity, whether they have any visually disabling symptoms such as glare and the severity of the symptoms, the impact of any visual disability on the patient’s ability to function including the ability to undertake their occupation such as a bus or lorry driver, maintain independence and remain safe including the risk of falls, and the impact on their ability to conduct any activities which are important to them and/ or which require particularly good vision. The benefits of second eye surgery have been demonstrated and patients with bilateral cataract should be offered second eye surgery provided they meet the criteria.

Patients may benefit from cataract surgery in the first or second eye when:

• The patient has confirmed that they wish/agree to be referred to consider surgery.
• They have evidence of significant cataract on assessment and meet any of the criteria below.

Criteria:

• Acuity: corrected monocular VA is 6/12 or worse (0.30 logMAR)

OR

• Visual disability: The patient can no longer undertake their usual activities such as reading, driving or particular activities relating to their employment. NB DVLA Group 2 drivers require a higher standard of visual acuity in order for them to be able to drive.

OR

• The patient experiences visual symptoms attributable to cataract: e.g. significant glare and dazzle in daylight, or difficulties with night vision or driving due to the lens opacity.

OR

• The patient has an increased risk of falls, difficulty with self-care or the activities of daily living due to their visual impairment, and/or are at increased risk of falls due to their visual impairment.

OR

• The patient is a carer for a relative/ dependent, and their vision impairs their ability to provide essential care.

Exclusions

This policy does not apply to patients who require cataract surgery for any of the following reasons:

• The patient has, or is predicted to have, 2.00 dioptres or more of induced anisometropia, either from an increasing cataract or from first eye cataract surgery, which is causing, or expected to cause, symptoms secondary to optical imbalance;
• The patient has a co-existing eye condition, and the removal of the cataract is required to enable better surveillance or management of the condition, for example diabetic and other retinopathies, age-related macular degeneration, glaucoma, inflammatory eye disease or neuro-ophthalmological conditions;
• The patient has corneal or conjunctival disease where cataract removal would reduce the risk of losing corneal clarity or reduce the risk of complications;
• The patient has a rapidly increasing refractive error which is primarily due to the presence of the cataract;
• The patient has post-vitrectomy cataracts which hinder the retinal view or result in a rapidly progressing myopia.

Compliance with NICE guidance: NICE NG77 recommends not to restrict access to cataract surgery on the basis of visual acuity.

NOTE: Surgeons may elect to insert toric lenses provided that this is the most appropriate implant at a cost equal to standard lenses.