Cataract Surgery

Threshold

The potential to benefit from cataract surgery depends on several factors including the patient’s visual acuity, whether they have any visually disabling symptoms such as glare and the severity of the symptoms, the impact of any visual disability on the patient’s ability to function, maintain independence and remain safe, and the impact on their ability to conduct any activities which are important to them and/ or which require particularly good vision.

The benefits of second eye surgery have been demonstrated and patients with bilateral cataract should be offered second eye surgery provided they meet the criteria.

Patients may benefit from cataract surgery in the first or second eye when:

They have evidence of significant cataract on assessment.
AND any of the following (but not limited to):

Visual disability: can no longer undertake their usual activities such as reading, watching television, or particular activities relating to their employment (if applicable).
Where the presence of cataract is preventing a patient from meeting the DVLA visual requirements for their current form of driving licence.
Significant glare and dazzle in daylight or difficulties with night vision, due to the lens opacity. This may particularly affect patients who need to drive at night.
The patient has difficulty with activities of daily living or self-care, and/or are at increased risk of falls due to impaired vision.
They are a carer for their partner or other dependent adult and the cataract limits their ability to provide care.
The patient has significant optical imbalance between the two eyes (anisometropia) which will be reduced or resolved by removal of the cataract (this may be the result of cataract surgery on the first eye).
The patient has a refractive error / myopic shift which is primarily due to the presence of the cataract.
To treat existing angle closure glaucoma or prevent future angle closure glaucoma (in eyes with cataract deemed at significant risk of future angle closure).
To improve intraocular pressure control in eyes with glaucoma and inadequate intraocular pressure control.
To treat lens-induced ocular disease (e.g., phacolytic glaucoma, phacomorphic glaucoma, phaco-anaphylactic uveitis, etc.)
The patient has corneal or conjunctival disease where cataract removal would reduce the risk of losing corneal clarity or reduce the risk of complications.
The patient has a co-existing eye condition, and the removal of the cataract is required to enable better surveillance or management of the condition, for example diabetic and other retinopathies, age-related macular degeneration, glaucoma, inflammatory eye disease or neuro-ophthalmological conditions.
The patient has post-vitrectomy cataracts which hinder the retinal view or result in a rapidly progressing myopia.

Note: NICE NG77 recommends that access to cataract surgery should not be restricted based on visual acuity.

NOTE: Surgeons may elect to insert toric lenses provided that this is the most appropriate implant at a cost equal to standard lenses.

Cases for Individual Funding Consideration (Patients who do not meet the policy criteria)

On a case-to-case basis, patients might be eligible for surgical intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.

Feedback

This is a new Cataract Threshold Policy for Norfolk and Waveney that will be reviewed 12 months after implementation. If you wish to share any feedback, please contact Norfolk and Waveney Clinical Policy Development Group at nwicb.cpdg@nhs.net .