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.