• All patients should have assessment by an Optometrist prior to referral
• An Optometrist assessment is essential in all patients, because some patients can improve their visual acuity simply by a change of the prescription in their glasses.
• The Optometrist also provides documented visual acuities for distance and for near, with and without corrective spectacles or contact lenses and the refractive power of the eyes. This information is needed to determine the power of the intraocular lens implant, should there be a decision to proceed with cataract surgery. The Optometrist could assess the degree of cataract present (i.e. not clinically significant, mild, moderate or severe cataract) and macular changes that can compromise the outcome of cataract surgery.
• Optometrists within D&G can refer directly via SCI Gateway but optometrists across the border cannot so GPs may still occasionally receive forms from optometrists requesting referral. When the practice receives a form back from the Optometrist this can be scanned and attached to a Gateway referral. It is not necessary for the GP to see the patient as the optometrist will have checked the need for referral and whether the patient is amenable to surgery.

• Please refer only patients with functional impairment of vision
• A brief assessment of the patients' visual requirements for day to day activities for living (visual function) is important to decide whether referral is necessary to attend the optometrist and then the Eye Clinic. Patients should only be referred for consultation if their vision from cataracts sufficiently impairs their way of life (e.g. watching television, reading, driving and pursuit of sports, hobbies or employment).

• Please refer only patients if they are in principle keen to have surgery
• The visual acuity level alone is not the sole criteria for cataract surgery because all surgical interventions carry the risk of problems and complications. Patients need to be provided with realistic expectations to avoid disappointment and patients with pre-existing good visual acuities often have the highest expectations. There is a small but ever-present risk of total blindness from cataract surgery and as such patients should only be referred for cataract surgery if they have impaired visual function and are keen, in principle, to have cataract surgery.

The optometrist assessment will include the information outlined in the 2 bullet points above.