Threshold

Norfolk and Waveney CCGs will fund cataract surgery where there is a clinical impression that it is in the best interests of the patient AND where ALL of the following criteria apply:

• First Eye: BCVA* of 6/12 Snellen or worse in that eye.
• Second Eye: BCVA* of 6/18 Snellen or worse in that eye.
• The cataract(s) is/are producing symptoms resulting in detriment to quality of life, in particular compromising independence.

NB: Where both eyes are eligible for surgery, the eye with the poorer BCVA must be operated upon first except where either:

• the reduced level of acuity in the poorer eye is due to a condition other than cataract or:
• the patient’s symptoms are more pronounced in the eye with the better BCVA
• where surgery on the first eye has not resulted in an improvement to a Best Corrected Visual Acuity of better than 6/12, the threshold for the second eye should be 6/12 rather than 6/18.’

*Best Corrected Visual Acuity (BCVA) i.e. visual acuity after correction of any refractive error, achieved after correction with spectacles / contact lenses / other adjustments

Cataract surgery will be funded without consideration of the level of BCVA where it is in the patient’s best interests and where ANY of the following criteria apply:

• Where posterior sub-capsular and/or cortical cataract is resulting in significant and disabling glare.
• Where cataract surgery is necessary to permit the surveillance for/of, or treatment of, diabetic retinopathy.
• To treat existing angle closure glaucoma, or prevent future angle closure glaucoma (in eyes with cataract deemed at significant risk of future angle closure).
• To improve intraocular pressure control in eyes with glaucoma and inadequate intraocular pressure control.
• To correct significant anisometropia (asymmetry of right and left eye refractive error of sufficient magnitude to compromise spectacle tolerance); where anisometropia of at least 1.50 dioptres is present (where anisometropia is defined as asymmetry of either the spherical equivalent refraction or the principal refractive meridians of the two eyes), or where anisometropia of at least 1.00 dioptres is present AND the patient has suffered spectacle intolerance attributable to the refractive asymmetry.
• To treat lens-induced ocular disease (e.g. phacolytic glaucoma, phacomorphic glaucoma, phaco-anaphylactic uveitis etc.)
• Where there is a rapid cataract-induced myopic shift in refractive error progressing at a rate of no less than 1 dioptre per year (documented by subjective refraction).
• Where the presence of cataract is preventing a patient from meeting the DVLA visual requirements for their current form of driving licence.

Where a reliable measurement of visual acuity is not possible due to learning disability / cognitive impairment (or similar circumstance) but cataract surgery is deemed to be in the patient’s best interests.