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St. Richard’s Hospital SPECIALTY: OPHTHALMOLOGY CLINICAL PROBLEM: CATARACT DEFINITION: An opacity of the crystalline lens Symptoms caused by the presence of cataract Blurred Vision Glare Change in colour appreciation Monocular diplopia or distortion Rapid change in refraction or differences of refraction between the two eyes Threshold for Cataract Surgery When vision compromises the normal daily activity and it is considered that the operation would benefit the patient to an extent that outweighs the risk (e.g. infection and haemorrhage). It does not depend on the degree of development of the cataract or whether it is unilateral or bilateral, or on any specific level of vision. Clinical criteria for cataract surgery • The presence of cataract interfering with visual function and the reasonable expectation on the part of the surgeon and patient of improvement of visual function and enhanced quality of life when visual rehabilitation is completed. • To permit examination and treatment of lesions affecting the posterior segment of the cataractous eye (e.g. diabetes). • To avoid lens-induced ocular disease (rare). Specific indications for cataract surgery • • When, in the presence of a cataract, the standard of vision is inadequate for the patient's needs. When, in the presence of a cataract, the patient is unable to see well enough either to work safely or to obtain a driving licence. If a unilateral cataract is present, loss of binocular vision can occur or be a problem for drivers, for those people who work at heights or require binocular vision for their occupation or pastimes. : Refer if ‘Do Not • • • • The patient does not want surgery. The patient’s lifestyle is not affected by the presence of cataract. Spectacles or other visual aids provide satisfactory functional vision. The patient’s medical condition is such that the risks of anaesthesia and surgery outweigh the potential benefits. Day Surgery The majority of cataract surgery is performed under local anaesthesia as a day case. PRACTICE POINTS All referrals for cataract surgery must be accompanied by • a copy of a recent optometrist’s refraction and findings with any referral for cataract surgery. (GOS18) • a drug history and details of the patient’s general health. Cataracts do not need to be ‘ripe’ or mature to be removed. Patient’s with early cataract do not need referral to assess the maculae. SOURCE : The Royal College of Ophthalmologists, Guidelines for Cataract Surgery, 2007 AUTHOR: Mr Peter Fox, Consultant Ophthalmologist, Western Sussex Hospitals NHS Trust. OTHERS INVOLVED: Mr. Sal Rassam and Mr Thisara Niyadurupola, Consultant Opthalmologists; Mr C. Walsh & Mr R. Tildesley, Ophthalmic Opticians and all LRMG Committee Members, St Richards Hospital Chichester. PUBLISHED: 3/96 REVIEWED: 10/00 08/06 03/09 NEXT REVIEW: 03/11