What is eye surgery for cataracts?
A cataract exists when the lens of an eye becomes cloudy and may affect vision. Cataracts most commonly occur in older people and develop gradually.
Cataracts can usually be treated with a routine day case operation where the cloudy lens is removed and is replaced with an artificial plastic lens (an intraocular implant). Cataract eye surgery is a relatively straightforward procedure that usually takes 30 to 45 minutes.
It’s often carried out as day surgery under local anaesthetic, which means the patient will be awake during the procedure and can go home on the same day. During the operation, the surgeon will make a tiny cut (incision) in the patients eye so the affected lens can be removed. After it’s been removed, a small plastic lens will be inserted.
If the patient has cataracts in both eyes, the patient will have two separate operations. This gives the first eye time to heal and time for the patients vision to return.
Patient eligibility criteria:
Eye surgery for cataracts is restricted. This means the patient's local Clinical Commissioning Group will fund the treatment if the patient meets the stated clinical threshold for care.
If the clinical threshold is not met, the clinician in charge of the care of the patient’s specific condition, usually a hospital doctor or optometrist can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation. See separate leaflet for more information on Individual Funding Requests (IFRs).
- The patient’s lifestyle is affected by disabling visual symptoms attributable to cataracts such as:
- Difficulty carrying out everyday tasks such as recognising faces, watching TV, cooking
- Playing sport and driving; reduced mobility, unable to drive or experiencing
- Difficulty with steps or uneven ground and the ability to work, give care or live independently is affected.
This information, together with a report from a recent sight test, should form the minimum data required to be referred for surgery.
Other indications for cataract surgery include treatment for one or more of the following:
- Monitoring disease of the area behind the lens of the eye (posterior segment disease)
- Correcting lazy eye (anisometropia)
- Patients with glaucoma who require cataracts surgery to control fluid pressure in the eye.
This is because although clarity of vision remains a useful component of the assessment of visual disability from cataract, cataract surgery should be considered in the first eye or second eye of a patient who has disabling visual symptoms attributable to cataract. For instance, a patient who experiences disabling glare due to cataract when driving may still achieve clarity of vision (6/9) under ideal light conditions.
This recommendation is consistent with advice from the Royal College of Ophthalmologists, and where implemented in local commissioning guidance has been found to be practical and equitable.
Patients with single sight (monocular vision):
The indications for cataract surgery in patients with single sight, where vision in which both eyes are used separately (monocular vision) and those with severe reduction in one eye, are the same as for patients with binocular vision.
Advice and further guidance:
At first the patient's optometrist may be able to prescribe new glasses that will help with changes to the patient’s vision caused by the cataract. When this no longer helps the patient to see well enough, the only effective treatment is surgery. For more information search for ‘cataract surgery’ on the NHS UK website or read the 'cataracts decision aid'. See separate leaflet for more information on Individual Funding Requests (IFRs).
Treatment policy for patients covered by NHS Birmingham and Solihull CCG
Please note: On 26 October 2017 NICE issued new guidance, NG77 - Cataracts in adults: management. Birmingham and Solihull CCG will be reviewing the new guidelines and recommendations to determine what changes might be required to the existing treatment policy issued in October 2016.
In the meantime NICE has produced a range of information for public, patients and professional which can be viewed at: http://indepth.nice.org.uk/cataracts/index.html.