Referrals Flashcards
When general management doesn’t reduce sx, what do we need to do?
We need to consider the suitability for the px to have cataract surgery
What is the referral criteria for cataract surgery?
- how the cat affects the px’s vision and quality of life
- one or both eye effected
- what the surgery involves / pros and cons
- how the px’s quality of life is affected is surgery isn’t had
- whether they want the surgery
Is there a fixed level of acuity for the px to be referred for cat surgery?
No there’s no fixed acuity but a referral criteria
If a px is at risk of wet AMD or retinopathy, do we still need to refer them based on the severity of their lens opacity?
No, we do volk and also need to manage the other pathology and may need to have an emergency referral if needed.
(Most severe condition)
Why are px’s with cataract at risk of glaucoma?
Age related changes increase lens thickness which increases lens opacities. If the thickness increases, the iris can change position and compromise the drainage angle increasing iop
If a px is at risk of glaucoma with a cataract, what should we do?
Check whether the angle is getting affected by the increasing thickness of the lens and if the iris is affecting the angle, refer them because iol’s have reduced thickness compared to lenses filled with opacities
What guidance must be issued to px’s considering cataract surgery?
- what are cataracts
- how can they affect vision
- how can they affect the px’s quality of life
- what does surgery involve
- how long does surgery take
- risks and benefits
- support needed after
- recovery time
- long term outcomes
- life and vision affected without surgery
What is it meant by a direct referral?
Being referred straight to hes without being referred to gp and is faster
In order for a referral to occur, what must be done?
- a full eye exam including volk and lens assessment (dilation may be necessary if opacities are restricting fundus views and even if the opacities are too dense we must still dilate and attempt)
- discuss pros and cons or surgery
- discuss where the surgery should be and where they want it
What additional information may be needed from the px?
Transportation to and from surgery or any general health issues
If we find opacities and they are asymptomatic, what would we do?
We wouldn’t refer but it should be discussed with the px so they’re aware of it and it’s not a surprise
If the lens opacity causes sx what should we do?
We should have a discussion with the px and go through the referral criteria for surgery but firstly try optical management options
What should you ask about a px’s LEE?
Ask about any pathology or opacities mentioned
What should cataract px’s be be informed about?
They need to be informed about the presence/progression of lens opacities and they should have reassuarance about the prognosis and the possibility of requiring surgery
Why is reassurance very important for older px’s?
Because the parents and grandparents of those progressing for cataract surgery have the experience of cataract surgeries which weren’t very safe and didn’t have good outcomes
