Optometrist referrals for cataract and 'Action on Cataracts' guidelines: are optometrists following them and are they effective?

Purpose: To assess the information included in optometrist referrals for cataract to the Hospital Eye Service with reference to the recommendations made by the Department of Health in 'Action on Cataracts' and the resultant surgical listing rates. Methods: We prospectively collected and analysed the information included in three different types of optometrist referrals for cataract over 8 weeks. Referrals containing 'full information' as recommended in 'Action on Cataracts' confirmed cataract as the cause of visual loss with a detrimental effect on the patient's lifestyle, and a willingness for surgery. The referral outcomes were assessed in terms of listing rate and the reasons for not listing, for each type of referral form. Results: A total of 412 referrals were analysed. Of these, 50% (208) were 'conventional' referrals via the general practitioner (GP) [39% (n = 162) using the General Ophthalmic Services (GOS) 18 referral form and 11% (n = 46) an optometrist's custom letter]; 35% (n = 143) were direct referrals and 15% (n = 61) were GP referrals with no optometrist information (these results were excluded from further analysis). The listing rates for optometric referrals were 78% (n = 272) overall, 83% (n = 119) for direct and 74% (n = 153) for conventional referrals. 'Full information' was included in 17% (n = 8) of letter referrals and 10% (n = 16) of GOS 18 referrals. The listing rates were 83% for referrals with full information and 73% for referrals specifying only that cataracts were the cause of visual loss. The listing rates for referrals with partial information were 78% for 'cataract' plus 'effect on lifestyle' and 67% for 'cataract' plus 'willingness for surgery'. The most common reason for not listing a patient for surgery was 'no effect on lifestyle', accounting for 42% (n = 32). Conclusion: We recommend that all referrals for cataract should confirm a detrimental effect on lifestyle and the patient's willingness for surgery, in addition to confirming cataract as the main cause of visual loss.