Referrals for cataract and Action on cataracts, evidence-based guidelines

Stephen C Lash; Catherine Prendiville

The most common referrals made to ophthalmology units are for cataract with the majority of patients referred from the optometrist via the GP.1^–3 Increasingly we have direct referral from optometrists. We audited our referrals for cataract to assess the information included in the referrals and the outcomes in terms of listing for surgery and reasons for not listing.

We received 412 cataract referrals over a 2-month period, of which 15% (n = 62) were referred by the GP. Our ‘gold standard’ for information was taken from the document Action on cataracts,4 in which recommendations were made that cataract was the cause of visual loss, that this visual loss resulted in a detrimental effect on the patients lifestyle and the patient was willing to have surgery. The ‘gold standard’ was reached in 9.7% of referrals from GPs, 8.1% only included willingness for surgery, 3.2% only included effect on lifestyle and 79% just stated the presence of cataract. The overall listing rate for GP referrals was 72.5%. Analysing the full data set of referrals revealed that referrals containing the ‘gold standard’ information resulted in higher listing rates (85.2% [P = 0.029]) compared to referrals just stating the presence of cataract (75.8% [P = 0.716]).

Of the 17 GP referred patients not listed, the most common reasons were patient declining surgery (41% [n = 7]) and no effect on lifestyle (29% [n = 5]). These results were consistent with the full data set with no effect on lifestyle accounting for 41.5% (n = 32) and a further 9.1% (n = 7) of patients declining surgery. Other ocular pathology including macular degeneration 14% (n = 11) and glaucoma 5% (n = 4) accounted for relatively few patients not being listed for surgery.

GPs do not generally have access to slit lamps and fundus biomicroscopy and understandably may feel out of their depth. However, we have shown that when assessing the patient with cataract it is important to assess the effect on the patient's lifestyle and their willingness for surgery before referral, and would encourage all GPs to do this to reduce the number of patients referred prematurely for their cataract operation.

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(2000) Action on cataracts: good practice guidance (Department of Health, London) www.dh.gov.uk/assetRoot/04/01/45/14/04014514.pdf (accessed 9 November 2005.).