Cataract

6) Guideline for cataract referral in Birmingham

6.1 Following changes to the regulations and the implementation of patient choice you should, if appropriate, refer your patient directly to the hospital eye service according to your locally agreed protocol as advised by Birmingham LOC. The following provides you with guidance to help you with the clinical management of your patient and to maintain efficiency of eye services both in primary care (GOS) and secondary care (hospitals)

6.2 During the patient’s eye examination you will have determined the following:

  • Type and Severity of cataract (note visual acuity is not the only consideration)
  • Symptoms and history
  • Right and/or left eye
  • Effect on daily living (glare, flare, poor contrast sensitivity affecting small print)
  • Whether the driving standard is still met if patient is a driver
  • Whether the patient wishes to have surgery (no point in referring if patient does not consent unless there is co morbidity)
  • Whether there is any co-morbidity (It is always wise to dilate and carry out slit lamp bio where the cataract is obscuring a good view of the fundus by direct ophthalmoscopy)

6.3 Remember that poor visual acuity may be caused by factors other than the cataract a routine referral for cataract will take several weeks if not months. Should there be an underlying condition such as wet AMD such a delay would be disastrous.

6.4 From the above you will have discussed with your patient whether to refer or not.

If under the regulations a referral is not made you must rule out any co-morbidity by examination of the eyes with dilatation if necessary. You must make a full record of this decision and the reasons for it in your patient record and inform the patient of your reasons.

If you decide to refer, the patient will wish to have surgery, will have significant effect on their daily life or will have co-morbidity requiring referral.

6.5 Your referral form should preferably be typed but must be legible. It must contain the following:

  • Date
  • Full patient details; name, address, postcode, dob
  • Patient telephone number (preferable)
  • Your details; address and with your name in block capitals
  • Refraction details with acuities for both distance and near for each eye separately
  • Type and severity of cataract R and/or L
  • Details of symptoms and effect on daily life
  • Pertinent ocular history including whether amblyopia previously documented with date and details
  • Patients current medication (ask patient to take repeat prescription list to hospital appointment)
  • Any existing co-morbidity e.g. glaucoma, AMD, diabetes with or without retinopathy.

6.6 Please use the cataract referral form supplied by your PCT.

Patients have a choice as to where they may go for surgery. Once that choice has been made FAX or post your referral to the ophthalmology department of the chosen hospital. Details of Fax numbers for local acute NHS Trusts were sent with the cataract choice information.

You may claim the relevant fee for a direct cataract referral with choice of provider via the Webstar Optopay platform. Please contact the LOC Secretary for details of how to gain access to the website.