Policy Number: SRP 033
Policy Name: Cataracts/Lens Extraction
Status: Group Prior Approval
Effective Date: 1 April 2024
Next Review Date: 1 April 2026
Mid and South Essex ICB commissions surgery for cataracts/lens extraction in adults 18 years or older on a restricted basis.
Referrals should not be based simply on the presence of a cataract.
MSE ICB commissions surgery for cataracts/lens extraction where the patient
- is willing to have eye surgery. The referring optometrist or GP must discuss this with the patient before referring. The Shared Decision Support tool- making a decision about cataracts
Cataract referrals will not be accepted unless a formally documented shared decision-making process has been performed by their referring primary care optometrist with the patient (and their family members or carers, as appropriate) as part of a referral. This includes but is not limited to:
- How the cataract affects the person’s vision and quality of life
- Whether one or both eyes are affected
- What cataract surgery involves, including possible risks and benefits?
- How the person’s quality of life may be affected if they choose not to have cataract surgery
- Whether the person wants to have cataract surgery- patients who are not willing to have surgery must not be referred.
- AND with best corrected visual acuity 6/12 or worse in the worst eye assessed by the clinician as being due to a rectifiable lenticular opacity
- AND where the reduced visual acuity significantly interferes with activities of daily living, (not exhaustive list) such as:
- the patient is at significant risk of falls, or
- the patient’s vision is affecting their ability to drive, or
- the patient’s vision is substantially affecting their ability to work, or
- the patient’s vision is substantially affecting their ability to undertake leisure.
- activities such as reading, watching television or recognising faces or
- management of other co-existing eye conditions
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 records.
All referrals must be accompanied by a completed referral form, confirming compliance with the policy and providing the following information:
- Details of the optical prescription
- Corrected distance visual acuity
- Corrected near visual acuity.
- Co-existing other eye conditions, management and current status
- Other co-existing medical conditions affecting vision or the eyes; management and status e.g.
- Diabetes
- Glaucoma
- Any other medical condition impacting on vision
- Confirmation that the patient is willing to have eye surgery.
- Using the patient’s own words, the reasons why the patient’s vision and lifestyle are:
- adversely affected by the cataract, and the likely benefit from surgery must be included in the referral.
Second eye – patients will be offered second eye surgery provided they fulfil the referral criteria (see above).
Second eye surgery should be deemed urgent when there is resultant symptomatic anisometropia i.e. a large refractive difference between the two eyes resulting in poor binocular vision (this should be clearly recorded in the patient’s notes).
The ICB does not commission cataract surgery/lens extraction solely for the purpose of correcting longstanding pre-existing myopia (short sighted or near sighted) or hypermetropia (long sighted).
Patients not meeting the above criteria will not be funded unless there are clinically exceptional circumstances.
Individual funding requests should only be made where the patient demonstrates clinical exceptionality.
Find out more information on applying for funding in exceptional clinical circumstances
Reference: Shared decision making for cataract surgery – Evidence based medicine.