Tees Cataract Service Julie Breen LOC Chair and Tees Lead for the Cataract Service

Objectives The objectives of the service are: To diagnose those patients who require cataract treatment and check for other conditions To discuss the patients condition(s) with them and options available Provide the patient with relevant information Refer patient directly following Choose and Book procedures

Cataract Service Optometrists, having performed an eye examination and identified a cataract that is causing visual problems to a patient will provide the following service: Explain what cataract treatment involves and discuss options with the patient. Obtain patient’s consent to proceed with referral for surgery. Check fundii under mydriasis and record results on referral form. Complete cataract referral form up to and including “disabilities” section. Provide the patient with the Choice Booklet and telephone number of the Choice Team, in order for the patient to discuss choice of provider and arrange booking of their hospital appointment. Cont/…

Cataract Service To provide the patient with the RNIB Cataract Booklet or College of Optometrist leaflet Provide the lid hygiene/blepharitis advice leaflet and discuss the importance of good hygiene Where the patient has difficulty using the telephone to make an appointment the Optometrist will contact the Choice team on behalf of the patient during the consultation. Fax referral form to CHOICE/MARS team within 24 hours Co-morbidity precludes patients from referral via Direct Cataract referral and must be referred in the normal manner using a GOS18.

Service description/care pathway Patients will attend for a cataract assessment with accredited ophthalmic practitioners via self-referral, GP-referral or Optometrist referral If the Contractor is unable to provide for the assessment the Contractor, ophthalmic practitioner or other responsible person they shall direct the patient to an alternative provider of the services. A GOS or private sight test will reveal the presence of cataract and the examining ophthalmic practitioner will discuss with the patient options for further assessment and or treatment to the patient and make a referral in line with Choose and Book as necessary. If the cataract is not presenting any significant visual or lifestyle difficulties, then they will continue to be reviewed by the ophthalmic practitioner in the normal way

Risk Factors Discuss and document presence of the following risk factors: female gender - slightly increased risk age - cataracts present in approximately 70% of people age 85 years or older family history - heritability could be 48-59% presence of co-morbidities, e.g. – chronic uveitis – prior intra-ocular surgery, e.g. glaucoma filtration surgery or vitrectomy diabetes mellitus (DM) long-term use of systemic or inhaled steroids smoking excessive alcohol use previous eye trauma or surgery UV-B exposure dehydration or diarrhoeal crises irradiation extreme short-sightedness taking statins

Detailed visual history Obtain a detailed visual history: near and distance vision past history of eye disease binocular function amblyopia

Patient questions? Ask patient (suggested questions to ask): how cataract has affected their quality of life (QoL) whether the decline in visual acuity has precluded them from some occupations, e.g. ask what they are no longer able to do or enjoy to describe their own near and distant vision under varied lighting conditions whether they drive or not whether they take any medication that may increase the risk of surgery: – tamsulosin – other alpha-antagonists – anticoagulants

Ocular examination Perform a thorough ocular examination to include: check for refractive errors by assessing acuity with and without refractive correction assessment of pupil function measurement of intraocular pressure (IOP) slit lamp biomicroscopy of the anterior segment examine fundus for signs of retinal disorders evaluation of glare disability and reduced contrast sensitivity assess ocular motility and binocularity assess and categorise lens opacity

Please note... It is important that optometrists do not assess and refer patients already under the care of an ophthalmologist (e.g. for another active ocular condition). In such cases, the optometrist should refer the patient back to the ophthalmologist with a letter explaining the patient's current visual difficulties.

Staff competencies Qualified optometrist that has undertaken an accredited training programme approved by Hartlepool & Stockton CCG and South Tees CCG and must be registered with the General Optical Council. The nationally approved WOPEC distance learning module is to be completed.

Population covered The geographical areas of Hartlepool, Stockton on Tees, Middlesbrough and Redcar and Cleveland. The provider shall ensure that the patient is an eligible person by verifying the patient’s GP before providing the enhanced service. In order to qualify for a domiciliary GOS sight test, the patient must fall into one of the NHS eligibility categories and be unable to leave home unaccompanied. To be eligible for a domiciliary cataract assessment under the service, the patient must be able to travel to the treatment centre for treatment if suitable transport can be provided, and be able to co-operate with the procedure.