1.1.3 Identifies and responds appropriately to patients’ fears, anxieties and concerns about their visual welfare. Flashcards
Identify what element is patient worried about?
o Vision?
o Surgery?
o Complications?
o What happens if cataract left untreated?
Cataract explanation:
cataracts are formed when the clear lens inside your eye becomes cloudy or misty. It’s a gradual process which generally happens as we get older. It is generally a natural part of the ageing process and anyone who lives a long life will go onto develop cataracts. Cataracts develop very slowly and will cause your vision to worsen over time. When this happens, we can send you to the hospital for a simple procedure to remove to cloudy lens and replace it with a new clear lens. The surgery is generally very successful and is a quick day procedure under local anaesthetic.
If patient is unsure about referral initially
Explain that the visual outcome will not be worse if referral is delayed
Give an information leaflet for them to digest at their leisure & discuss with family
UV protection & smoking
Ensure px is aware they can return before recall if symptoms worsen; give name incase they decide they would like referred or have any questions
Say to the patient:
- As part of the health check of your eyes, I’ve found mild-mod cataracts developing in both eyes. Have you been made aware of these previously at all?
- If not, then explain what a cataract is as mentioned below
- If yes, then explain that it’s slowly progressing (if NS/cortical) and is starting to affect your vision
- “I can advise you when you need to be referred to your GP or hospital. Cataract surgery is one of the most common surgical procedures and in most cases can be carried out under local anaesthetic on a day-case basis, without an overnight stay in hospital.”
Symptomatic Cataract Questions
- Regarding your eyesight in the past month or so, how are you finding your vision overall when wearing your glasses (both eyes open)?
- How much has your eyesight been interfering with your life in general or with things you like to do?
- How has your eyesight been affecting your reading ability?
- Any issues with glare? Night vision?
- How has this been making you feel?
What are the risks?
Information needs to be communicated to patients with care and sensitivity.
1 :25 (4%) Any complication
1: 100 (1%) Risk of reduced vision
1:1000 (0.1%) Risk of total loss of vision
Note that the risk increases for factors such as dense cataract, high ametropia,
previous vitrectomy, pseudoexfoliation etc.
Risks, therefore, should only be discussed in approximate terms as individual risks
will be discussed prior to the operation at the hospital. The risk increases for factors
Can I choose not to have operation?
If not interfering with daily life, then safe to leave cataract in the eye. It is NOT more difficult to remove if delayed. It does NOT have to be “ripe” for the surgery but it may start to interfere with daily life if not treated.
Will I have new glasses after the surgery?
You may find that the Rx needs changing after the operation & so you’d be recommended to see an optician to obtain new spex. You may find it takes a few weeks to adapt to new glasses after surgery as the brain is adapting to the new Rx.
Will the cataract come back?
No, but after some months or years, you may find vision becoming cloudy & misty where cataract has been removed due to the sac containing replacement lens clouding up. It’s very easily treated with a painless laser treatment in a matter of minutes.
