I work in a community eye care practice and examine a lot of older people. Many of them have a cataract that does not require surgery as it does not affect their daily life. When I mention the cataracts to them I can tell from their body language that they are worried. Many don’t want to go to the hospital for surgery. Is there any way I can present this information without worrying my patients?

I have noticed that too. When I mention the presence of cataracts people think two things: firstly, that they have to go to the hospital for an eye operation, and secondly that they will lose their vision.

I have a close look at the cataract and take into account their visual problems and their visual acuities.

If the cataract is not affecting their daily life and they have at least 6/12 in one eye I will not suggest an operation unless they specifically ask to be referred. If they do want or need to be referred I let them know that the decision whether to operate or not will be decided after discussions with an ophthalmologist.

If the patient does not want to be considered for cataract surgery I use a simple grading scheme to give them an idea of how ‘bad’ the cataract is. Here’s how I approach this:

‘You have cataracts in both eyes but based on what you have told me and how well you can see I don’t think you are ready for a cataract operation. On a scale of 1 to 10 with 10 being a very bad cataract and one being a very slight cataract your score would be 2.’ You can enter any number here that is a combination of the appearance of and location of the cataract, its effect on daily life, and the visual acuities.

This is a useful clinical tool that doesn’t have much scientific basis but nevertheless gives the patient a reasonable idea of how bad, or good, things are.

I finish by saying that I’d like to arrange another examination for 12 months’ time to check to see if anything has changed with the cataracts. I make a note in the clinical records as to the grading I gave the cataract so I can refer to this at the next examination.

Judging from patients’ comments and body language this type of information provides understanding and comfort.


Submit a Comment

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

If you like EyeTools Questions of the Day…

Children’s Eye Examinations
How to Run a Successful Low Vision Clinic
How to Run a Successful Optometry Practice



– Optometry students
– Pre-registration and novice optometrists
– Optometrists returning to work
– Junior eye doctors
– Dispensing opticians and orthoptists preparing for refraction exams
– Contact lens opticians, clinical assistants and eyecare educators

Improve your optometry skills with introductory & specialist instruction videos, topical live & recorded expert webinars, presentations and book reviews.

Start with the first section, ‘Pre-refraction procedures’ free, then choose a monthly or yearly subscription. To see English captions, click the CC button on any video.