1.1.3 Identifies and responds appropriately to patients’ fears, anxieties and concerns about their visual welfare.

Question 1

Cataract explanation:

Answer 1

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.

Question 2

If patient is unsure about referral initially

Answer 2

• 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
  *

Question 3

Laymen’s of cataracts explanaition

Answer 3

• You will have an initial appointment to be asked of your general health to see if operation is suitable for you
• The doctor will assess & measure your eyes using special equipment to determine what strength lens to put in your eye (clear plastic lens). As a result, they may be able to correct your long or short-sightedness
• Cataract surgery is a straightforward procedure that usually takes 30 to 45 minutes.
• It’s often carried out as day surgery under local anaesthetic so it won’t be painful and you should be able to go home on the same day. Some people are offered sedation
• You will hear the eye doctor explaining what they are doing, and you may hear some vague movements around your eye
• During the operation, the surgeon will make a tiny cut in your eye to remove the cloudy lens and replace it with a clear plastic one.
• You will normally not need stiches but your eye will be covered to prevent knocks after the operation. Don’t drive but do have someone to be in your care for the next 24 hours & before the surgery
• Your doctor may prescribe eyedrops or other medication to prevent infection, reduce inflammation and control eye pressure
• With the NHS, you’ll usually be offered monofocal lenses, which have a single point of focus. This means the lens will be fixed for either near or distance vision, but not both.
• If you go private, you may be able to choose either a multifocal or an accommodating lens, which allow the eye to focus on both near and distant objects.
• Most people will need to wear glasses for some tasks, like reading, after surgery regardless of the type of lens they have fitted.
• If you have cataracts in both eyes it may be recommended that both eyes are treated on the same day. This procedure is known as immediate sequential bilateral cataract surgery (ISBCS). ISBCS is usually only recommended for people thought to have a low risk of complications. The surgeon will discuss this with you if this is an option.
• Otherwise, surgery is done 6 to 12 weeks apart to allow the recovery one eye at a time.

Question 4

Risks - cataract surgery

Answer 4

• 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
  such as advanced age, dense cataract, high ametropia, previous vitrectomy,
  pseudoexfoliation etc. but these will be addressed as necessary at the hospital
  visit(s).

Question 5

Say to the patient once cataract found:

Answer 5

• 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.”

Question 6

Symptomatic Cataract Questions (these are the MAIN questions):

Answer 6

1. Regarding your eyesight in the past month or so, how are you finding your vision overall when wearing your glasses (both eyes open)?
2. 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?
3. How has this been making you feel?

Question 7

Where are these Cataracts?

Answer 7

• Nuclear - in the middle of the lens, at the nucleus
• Cortical - start at the outer edges of the lens cortex
• Posterior subcapsular - forms near the back of the lens