Cataract Pathways

Cataract Referral Refinement

Participating Optometrists must be registered with the General Optical Council and on the CCG Accredited List of Providers for this service.

Care pathway

The patient may access the service following a sight test or they may be referred by their GP or by a non-participating optometrist . The optometrist shall ensure that the service user is eligible to access the service by verifying the patient has a Wolverhampton GP before providing the service.

There are 2 stages to the Pathway:

 

Stage One 

A routine GOS or private sight test will reveal the presence of cataract and the examining optometrist will discuss this with the patient.

If the cataract is causing no difficulties in lifestyle, the optometrist will continue to review the patient (in the normal way).

If the patient has visual difficulties (VA of 6/12 or less) and wishes to consider surgery, then the optometrist will discuss this and if the patient wishes to proceed, the optometrist will provide a self-assessment health questionnaire. This will help to establish suitability for surgery by highlighting other health and general health problems and possible contra-indications.

The assessment may be carried out at this time if:

  • The optometrist is accredited in the service
  • If time permits
  • If the patient agrees

If not, a further appointment is made for a full cataract assessment.

If the examining optometrist is not participating in the service, then a list of all optometrists in the Service will be provided to the patient so that they can arrange an appointment for the assessment. 

 

Stage Two

The accredited optometrist shall provide a full cataract assessment to gain relevant ocular, medical and social information. this helps to filter out those patients for whom cataract surgery is not appropriate and streamline secondary care services.

This will include: 

  • Pupil dilation and examination by indirect ophthalmoscopy in order to establish whether there are any co-existing ocular disorders
  • As well as cataract Discussion of the health questionnaire and any outstanding issues dealt with 
  • Communicating the relative risks and benefits of cataract extraction
  • Ascertaining the patient's willingness for surgery and suitability.

A patient self-assessment questionnaire will support the participating optometrist to differentiate between:

a)   Cataract patients who are not currently appropriate for referral for NHS treatment either because the patient chooses not to be considered for cataract surgery or because the patient has chosen to be referred privately.  

b)   Cataract patients who are suitable for referral.  

In this case, the supporting information provided with the referral will allow the provider to determine the most appropriate clinic for their needs.

Service users not requiring NHS referral

Some cataract patients will not require a referral to the cataract service for NHS treatment. These will be patients that:

a) Choose not to proceed with surgery, once they have been counselled on the risks and benefits of cataract extraction

b) Choose to be referred for private treatment rather than NHS surgery, once they have been assessed under the service.  

In these cases the GP should be informed and the fee claimed.

 

Stage Three

If the patient is willing to undergo surgery and the optometrist considers that they are suitable, then referral form will be completed and the optometrist will email a referral to the patients preferred hospital for Cataract referral through the Optomise system.

The optometrist will make every effort to ascertain the suitability of the patient for cataract referral and their willingness to undergo surgery. It will ultimately be the cataract service team that determines the most appropriate clinic route.

The optometrist will recommend that the patient continues to be monitored at appropriate intervals, if the cataract is not presenting any significant visual or lifestyle difficulties, with an optometrist of their choice.