Welcome to question of the day #379

Eyetools question of the day #379

I work in community practice and often see patients with cataract in one or both eyes and sometimes patients with posterior capsular thickening after having had a cataract removed. I refer them to an ophthalmologist for treatment but am not sure if I should prescribe them new glasses before referring so they can have the best possible visual acuity when waiting for the appointment. What should I do?

I also see patients with cataract and others with posterior capsular thickening who I refer to an ophthalmologist for treatment. These are the things I think about in order to decide whether to recommend new glasses for the period they are waiting for treatment.

For patients with cataract, I ask myself can I help the patient see better than they are already seeing with new glasses? If the answer is yes and I think the improvement in visual acuity will help improve quality of life then I consider the point below. If the answer is no, I can’t help them see any better then, I will not prescribe new glasses at this point and inform the patient that they should come back to me for new glasses after the cataract or cataracts have been removed.

If the answer is yes, then I consider how long it will take for them to have the cataract removed. If the answer is more than three months (and I have managed to improve their visual acuity) I will then recommend new glasses. I will advise the patient that I am recommending new glasses because I can help them see better while they are waiting to see the ophthalmologist but that they will have to have a new lens following the operation or two new lenses if they have both cataracts removed in a short space of time. I make sure that they understand this.

For patients with posterior capsular thickening I will probably not recommend new glasses until they have had YAG laser. The laser is unlikely to change the person’s refractive error but the presence of posterior capsular thickening causes blurred vision and makes it difficult for patients to make accurate decisions during subjective refraction. They find it difficult to decide which lens gives the best vision. It is likely that subjective refraction with untreated posterior capsular thickening will lead to a suboptimum prescription. I advise the patient if this and recommend that they arrange to see me again soon after they have had the laser.

My main aim is to make sure people have the best possible visual acuity but I take into account financial issues that would arise from a change in prescription over a short period of time.