NHS Lancashire and South Cumbria ICB regularly reviews its clinical policies to ensure they reflect the latest evidence-based guidance and best practice. This is a rolling programme and sometimes results in changes being made to the policies.
We are currently reviewing the Cataract surgery policy and would welcome your views on the proposed changes.
Cataract surgery is an operation to replace a cloudy lens in your eye with an artificial lens.
Cataract surgery is done to improve your vision if you have cataracts. Cataract is a very common condition mostly affecting older people.
Cataract is where the lens in your eye becomes cloudy, which can cause blurry vision and loss of sight. It mainly affects older adults (age-related cataracts) but can also affect children (childhood cataracts).
Surgery is the only way to get rid of cataracts.
There is currently no published clinical policy for cataract surgery within Lancashire and South Cumbria ICB. Neighbouring ICBs, including Greater Manchester and Cheshire & Merseyside, have established policy positions in place. Adopting a cataract policy for the LSC area would support greater alignment with regional ICBs and promote consistency in commissioning practice.
The policy follows NICE guidance.
New wording in full
1. Cataract surgery is routinely commissioned if any of the criteria listed below are satisfied:
• An assessment of the patient’s visual quality of life (using the assessment template below) suggests surgery is appropriate
or
• Significant ocular imbalance (anisometropia) due to progression of an existing cataract or following cataract surgery on the first eye
or
• Patients with glaucoma who require cataract surgery to control intra ocular pressure
or
• Patients with diabetes who require clear views of their retina to look for retinopathy
or
• Patients with wet macular degeneration or other retinal conditions who require clear views of their retina to monitor their disease or treatment (e.g. treatment with anti- VEGFs).
AND
2. For ALL cases, the following additional criteria (see Final Checklist below) are also satisfied:
• Fitness for surgery is considered to be adequate AND
• Patient consent is given (when fully informed of the likely benefits and risks)
TEMPLATE to ASSESS the VISUAL QUALITY of LIFE
(As an opening question, it is useful to ask the patient whether there are any activities which they used to do in the past, which they would be keen to do again, but their poor vision is stopping them. This gives an initial impression which should then be supplemented by asking the detailed questions below) Questions
Response A
Response B
Response C
1. How well can the patient see objects in the distance when wearing the appropriate spectacles?
Without difficulty
With slight difficulty
With great difficulty
2. How well can the patient see writing on the TV and/or road signs when wearing the appropriate spectacles?
Without difficulty
With slight difficulty
With great difficulty
3. How well can the patient recognise people on the street at a distance when wearing the appropriate spectacles?
Without difficulty
With slight difficulty
With great difficulty
4. How well can the patient see the text in a newspaper, book or screen when wearing the appropriate spectacles?
Without difficulty
With slight difficulty
With great difficulty
5. How often does the patient experience glare when it is sunny, or experience light scatter from lights at night, to the point that they find it uncomfortable or difficult to function normally as a result?
Without difficulty
With slight difficulty
With great difficulty