NICE guidance on cataracts – base it on patient need, not eye tests

Eye care health professionals at Peninsula NHS Treatment Centre in Plymouth have welcomed the latest guidance from the National Institute for Health and Care Excellence, which states that the NHS should stop rationing or delaying cataract surgery. 
 
The guidance also states that the NHS should take a ‘patient-centred’ approach and base the need for surgery on patient need and not just an eye test.
 
Sir Andrew Dillon, chief executive of NICE, said: “Cataract surgery is one of the ways in which the NHS can transform our lives. Our guideline will help patients with cataracts and those treating them to make choices about the treatment they should have. We are asking NHS organisations to compare their current practice with our recommendations and to consider what changes may need to be made to put them into practice. In considering any changes, they will need to take into account any extra costs they may incur.”
 
Cataract surgery is the most common procedure carried out by the NHS, with around 400,000 operations a year. 1300 each year are performed at Peninsula NHS Treatment Centre.
 
It is estimated that around 2.5 million people aged 65 and over in England and Wales have some form of vision impairment caused by cataracts. While cataracts can interfere with everyday life if left untreated, cataract surgery is a successful procedure with good results for almost all patients – and treatment is available on the NHS. Ken Hosie, Medical Director at Peninsula NHS Treatment Centre, describes the condition and its treatment.
 
Cataracts are a common eye condition. As you get older the lens inside your eye gradually changes and becomes less transparent and this affects your ability to see. 
When the lens becomes cloudy, light cannot pass directly through it and you may notice problems with your vision. A cataract is not a growth or a film growing over your eye; it is simply your lens becoming misty.
 
The healthy lens helps to bend light rays entering the eye so that they may fall on the retina lining the back of the eye.
 
The most common reason for cataracts is growing older when natural changes within the lens occur. Most people over the age of 65 have some changes in their lens and the majority of us will develop a cataract in time. Other common causes of cataract include: diabetes, medications such as steroid eye drops, and previous eye surgery. There is research into other factors which may affect cataract development such as: smoking, lifelong exposure to sunlight, poor diet lacking antioxidant vitamins. In general, the reason for the cataract will not affect the way it is removed.
 
Once a cataract starts developing, and it can be a slow process, the lens loses its transparency and also its ability to change shape. This causes a gradual blurring of vision and a change in the effectiveness of a person’s vision with or without their glasses. Often a person with a cataract will go to their optician believing their glasses are no longer strong enough and learn for the first time about their cataract.
 
Cataracts may develop with different shapes and growth patterns. The most common cataract affects the whole lens with symptoms of gradual loss of colour, vision and blurring. Some cataracts will affect the very central part of the lens and come on over a few months causing real difficulty with night-time glare and be especially noticeable while driving.
 
Some symptoms of cataracts:
Cloudy vision
Changes in colour vision
Glare while driving
Glare during the day
Glasses prescription changes (increased frequency)
Double vision or ghosting of images (especially if only noticeable in one eye)
 
What causes cataracts?
 
Natural ageing changes (most cataracts are formed this way)
Secondary from other illnesses such as diabetes or medications
Previous eye surgery
Babies can be born with congenital cataracts
 
What if I suspect I have a cataract?
 
You need a professional eye examination by your optician or ophthalmologist (after referral by your GP).  If your vision can be corrected to an acceptable level with glasses or contact lenses surgery may be avoided at this time. If your vision loss cannot be corrected by the above measures and if this interferes with your daily life (driving, watching television, hobbies) then your cataract will need to be removed surgically.
 
What does cataract surgery involve?
 
Cataract surgery is the removal of the cataract and insertion of an artificial lens called an IntraOcular Lens Implant (IOL) into the eye. It is the most successful and most frequently performed operation in the UK with around 400,000 cases annually. Far more than 90 per cent of patients operated on have a significant improvement in their vision. The operation can be performed at any stage of cataract development. There is no need to wait until your cataract is “ripe” before removing it. Most people choose to have their cataracts removed when the change in their vision starts to cause them difficulties in everyday life, such as driving, cooking, or reading. Cataract surgery usually takes about 10 – 15 minutes and most people go home from hospital about two hours later. It is done under local anaesthetic, which means you will be awake during the operation but you will not feel any pain. The local anaesthetic may involve eye drops and/or a very small pellet which will slowly dissolve in the eye . After the operation, you will need to put drops into your eyes for a few weeks. Lasers are not used to remove cataracts and there is no evidence to suggest that changing your diet, taking vitamins or using eye drops can cure cataracts. 
 
Can cataracts be prevented?
 
To date there is no proven method of preventing cataracts. It is very important to have regular eye examinations (every two years for adults and then every year after the age of 50) as conditions that may affect your eye health become increasingly common with age.
 
Please ask your local optician or doctor if you have any risk factors or indications that cataracts may be affecting your vision.