Patterns in cataract referral: room for improvement?

Purpose: Optometrists are expected to refer patients with any abnormality of the eye excluding normal changes due to age to their general practitioner. It can be difficult to decide when a cataract ceases to be a normal age‐related change and becomes an ocular abnormality. This study examines the criteria adopted by optometrists and GPs for referring patients with cataract and compares this to the referral criteria suggested by ophthalmologists. Method: Questionnaires were sent to all optometrists and GPs registered with Birmingham Health Authority and ophthalmologists in the West Midlands area. Questions covered methods of subjective and objective assessment of lens opacities, subjective referral criteria, and views on communications between the three professions. Results: For all professions, the main factors influencing referral are visual acuity, subjective visual impairment and the need to drive. Optometrists and GPs generally refer patients with cataract at a VA level of 6/18–6/24, whilst ophthalmologists would be willing to see patients with cataract at a VA of 6/9–6/12. However, most ophthalmologists report that sometimes patients are referred too soon, regardless of their acuity level, because the patient is not yet impaired by their level of vision or does not want surgery. Conclusion: Suggestions for improvements in the referral of cataract will be discussed. It is important for optometrists to make clear whether a letter to a GP is for information only or referral. If referral is warranted the following information, in addition to acuity, will assist an ophthalmologist in prioritizing appointments: age, occupation, brief description of disability and the need to drive legally.