Prioritisation for cataract surgery

If you and your eye surgeon agree that you are likely to benefit from cataract surgery, and you agree to have surgery, this will be arranged.

Where there is a high need for services, you will be put on a waiting list for surgery. Most hospitals use a system that makes sure that patients with the greatest need for surgery are scheduled for cataract surgery first. This means that the severity of your vision problems and their impact on your life should be taken into account. For example, poor eyesight can affect your ability to work, drive, cook, read and write, or your ability to care for yourself or others. Your clinicians will also consider any other health conditions you have and your risk of falls. Some health conditions may make it more urgent for you to have cataract surgery, while others could mean that surgery is less likely to help you.

Let your GP, optometrist or eye specialist know if your vision worsens or other circumstances change while you are on a waiting list for cataract surgery.

Take into account organisational protocols for prioritising patients in your local health service, and provide information to assist structured and consistent prioritisation. Assess and document visual impairment and vision-related activity limitations, using a standardised tool if required.

At an individual patient level, the benefit of, and relative priority for, surgery are usually based on expert clinical judgement, taking into account the degree of visual impairment, the impact of visual impairment on activities of daily living (vision-related activity limitations), the risks of delayed surgery, any relevant comorbidity and the expected benefit of surgery.

When patients are being prioritised for surgery across a health service organisation, standardised protocols may be used to assess these factors systematically. Prioritisation protocols should enable those patients at greatest risk of harm from delayed surgery and those who are most likely to benefit from surgery to be treated first. Potential harms associated with delayed surgery include risks of falls or traffic accidents, or increased complexity of later surgery – for example, in patients with densely brunescent or white cataract.⁴ Social factors that may affect the ability of patients to access care, should also be considered, including remoteness, language and culture.

Comorbid conditions that may increase the urgency of cataract surgery should be considered in the prioritisation process. These include acute angle glaucoma and posterior segment disease, where fundal access is required for monitoring or treatment.

Ensure that protocols are in place to support prioritisation of patients according to their clinical needs and other key factors, based on a full ophthalmology assessment. Prioritisation protocols should include consideration of the patient’s visual impairment and vision-related activity limitations, comorbidity, potential harms from delayed surgery and potential to benefit. Social factors that may affect the ability of patients to access care should also be considered in protocols where relevant locally, including remoteness, language and culture. Surgery is scheduled based on this protocol. Monitor and, if necessary, reassess patients while they are on the waiting list in case their circumstances change.

Consider using validated tools or agreed clinical criteria to enable standardised assessment and documentation. Implement prioritisation protocols as per the requirement of the health service, or the state or territory health department.⁵⁹ Examples of tools that could be considered and adapted are listed in Box 3, see Cataract Clinical Care Standard full document. Implement tools and protocols within a quality improvement framework, monitoring their use to ensure that desired outcomes are being achieved. These include whether criteria are being consistently applied, timeliness of surgery, clinician perceptions and patient-reported outcomes. Where there is variation, assess the effectiveness of prioritisation protocols in the context of NSQHS Action 1.28.