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Improving cataract referrals in Scotland: What is an urgent cataract?

Eye (2024)Cite this article

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We read with interest about proposed efforts to improve cataract services in Scotland through development of core data sets, intended to refine referrals from community optometrists [1]. Provision of mandatory information should ensure appropriate triage, leading to optimisation of one-stop vs two-stop cataract delivery services. We agree the lack of referral standardisation is a safety concern. Missing clinical details can increase the risk of not identifying patients at greatest potential for harm. However, ambiguity remains as to prioritisation of surgical care.

We have previously highlighted variability of quality objective data within pre-pandemic ‘urgent cataract’ referrals in NHS Greater Glasgow & Clyde [2]. In 128 referrals between 2018 and 2020, 6.3% had no VA documented, 13.3% had no refraction, and 26.6% had no IOP recorded. 56% had BCVA 6/12 or better, highlighting the inconsistency between objective VA and lifestyle impact. 71.8% included subjective comments (“driver” (16.4%), “recent falls” (15.6%), “unable to work/perform daily activities” (10.9%), “only eye” (6.3%), and “terminal ill-health” (2.3%)). Despite the perceived referral urgency, 13.3% didn’t convert to surgery.

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References

  1. Court H, Dougall J, Pooley J, Improving cataract referrals in Scotland: developing a core mandatory data set for referral from community optometry for cataract surgery. Eye. 2024. https://doi.org/10.1038/s41433-023-02922-0.

  2. Nairn J, Lockington D, Analysis of “Urgent” cataract referrals from community optometrists in the west of Scotland. Eye News. 2021. Available from: https://www.eyenews.uk.com/media/24822/eyejj21-lockington.pdf.

  3. The Royal College of Ophthalmologists. COVID-19: Prioritisation of ophthalmic procedures. 2020. Available from: https://www.rcophth.ac.uk/wp-content/uploads/2020/08/COVID-19-Prioritisation-Of-Ophthalmic-Procedures_May2020.pdf.

  4. National Institute for Health and Care Excellence. Cataracts in adults: management NICE Guideline [NG77]. 2017. Available from: www.nice.org.uk/guidance/ng77.

  5. College of Optometrists. Guidance for Professional Practice. Annex 4. Urgency of Referrals. 2024. Available from https://www.college-optometrists.org/clinical-guidance/guidance/guidance-annexes/annex-4-urgency-of-referrals-table.

  6. El-Abiary M, Loffler G, Young D, Strang N, Lockington D. Assessing the effect of Independent Prescribing for community optometrists and referral rates to Hospital Eye Services in Scotland. Eye. 2021;35:1496–1503.

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Authors and Affiliations

  1. Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK

    Jonathan Nairn, Mostafa Khalil, Gordon Brown & David Lockington

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  1. Jonathan Nairn
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  2. Mostafa Khalil
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  3. Gordon Brown
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  4. David Lockington
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Contributions

DL had the initial idea. JN, MK, and GB collected the data and drafted the article. DL revised the article and provided senior support. All authors agree with the final submitted version.

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Correspondence to David Lockington.

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Nairn, J., Khalil, M., Brown, G. et al. Improving cataract referrals in Scotland: What is an urgent cataract?. Eye (2024). https://doi.org/10.1038/s41433-024-03111-3

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