|Title:||Clinical Guidelines for the Management of the Public Cataract Surgery Wait List|
|Document ID:||Operational Circular OP 1849/04|
|Date of issue:||Thursday, 30 September 2004|
|Status:||NO LONGER APPLICABLE|
|Description:||This Operational Circular details the clinical guidelines to be followed when determining the placement of patients on the public waitlist for cataract surgery. The guidelines have been prepared by the Director, Statewide Ophthalmology Services and are based on the Preferred Practice Patterns issued by the Royal Australian and New Zealand College of Ophthalmologists.|
|Period of effect:||from 28 September 2004|
|Authorised by:||Dr Andrew Robertson, Acting Chief Medical Officer
Acting Deputy Director General, Health Care, 28-Sep-2004
|Print version:||View print version|
Clinical Guidelines for the Management of the Public Cataract Surgery Wait List
This Circular details the clinical guidelines to be followed when determining the placement of patients on the public waitlist for cataract surgery. The guidelines have been prepared by the Director, Statewide Ophthalmology Services and are based on the Preferred Practice Patterns issued by the Royal Australian and New Zealand College of Ophthalmologists.
Addition to Public Waitlist for Cataract Surgery
Following the diagnosis of a cataract and assessment of the patient's suitability and consent for surgery, the patient may be added to the public waitlist for cataract surgery.
The addition of a patient to the waitlist should be done on the basis of the clinical guidelines outlined and only when the patient is at ready-for-care status. Clinical audits of the cataract waitlist will be undertaken on a regular basis and any patients not ready for surgery will be removed from the waitlist.
Diagnosis of Cataract
The pre-operative assessment of the cataract patient should be performed by the ophthalmic surgeon, who is to perform the procedure, or by an ophthalmic colleague. Assessment will include the need for surgery and the patient's suitability for day surgery.
Diagnosis of cataract is made by the presence of lens opacity, which contributes to or solely causes visual impairment.
Assessment of Visual Impairment in the Cataract Patient
No single assessment or test adequately describes the effects of cataract and the impact on the patient's visual status or functional ability.
The patient's symptoms of blurred vision, photophobia, monocular diplopia or distortion, change in colour perception, history of significant myopic shift, as well as assessment of both near and distance visual acuity, are important.
The Snellen chart measurement of visual acuity may not fully reveal the level of visual impairment from cataract. In addition to the patient's symptoms and Snellen Acuity, practitioners could give consideration to the use of contrast sensitivity and glare testing to document visual disability objectively. When necessary, potential vision testing (laser interferometer) can be used pre-operatively to establish the visual potential.
Comprehensive Pre-Operative Eye Examination
This should include examination of both eyes, as well as accurate keratometry and A-scan axial length ultrasound measurements.
General Medical Conditions
The patient's suitability for the surgery should be assessed, including the patient's ability to lie supine for the surgery and current anti-coagulation therapy as well as other conditions. It is desirable that the patient's general medical practitioner and/or optometrist be advised that surgery is to be undertaken.
No clear evidence currently exists for the routine management of the anti-coagulated patient. Intraocular surgery on anti-coagulated patients has been conducted safely and cessation of anti-coagulation may be associated with systemic morbidity. Individual circumstances, including the reason for anti-coagulation, should be reviewed to determine the type of anaesthesia, the surgical technique and the timing of surgery.
Threshold for Surgery
The decision to advise a particular patient to proceed with cataract surgery should occur after all factors have been considered and the benefits for the patient are felt to outweigh risks. Factors to be taken into account include the patient's age, occupation, home conditions, family circumstance, hobbies, general health, ability and need to drive a motor vehicle, as well as the condition of the eye apart from the cataract.
The decision to proceed with cataract surgery may vary from patient to patient depending on a variety of circumstances.
Cataract Surgery in the One Eyed or Monocular Patient
While the indications for surgery are the same as for the two-eyed patient, the threshold for intervention may be different. The ophthalmologist must explain the risk of total blindness if severe complications should occur.
Other Indications for Cataract Surgery
Cataract Surgery in the Second Eye
The indications for cataract surgery are identical to all those for the first eye. The improvement in visual function after second eye surgery is often better than the best pseudo phakic-eye vision due to binocular summation and is a factor to be considered in deciding when second eye surgery is worthwhile.
Where possible, a suitable time after the first eye surgery should be allowed for the onset and treatment of any of the immediate post-operative complications which may occur before second eye surgery.
Dr Andrew Robertson
This circular last updated: Thursday, 30 September 2004 at 12:00am