What are the key clinical signs and symptoms that indicate a patient may have cataracts and require referral?

Key clinical signs and symptoms indicating a patient may have cataracts and require referral include:

• Progressive visual impairment such as blurred or cloudy vision affecting one or both eyes.
• Difficulty with glare from lights, including disabling glare, even if visual acuity is relatively unaffected.
• Double vision in the affected eye(s).
• Refractive changes or a sudden unexpected need for new glasses (refractive surprise).
• Reduced visual acuity measured by an optometrist, particularly monocular visual acuity of 6/18 or worse, binocular visual acuity of 6/12 or worse for non-drivers, or 6/9 or worse for drivers, or if the patient cannot meet DVLA minimum sight requirements for driving.
• Significant impact on quality of life due to vision changes.
• In children or babies, signs such as an opacity or absence of red reflex, white pupillary reflex (leukocoria), or inequality in colour or clarity of the red reflex require urgent referral.

Referral is typically initiated by an optometrist after confirming the diagnosis and excluding other causes of visual impairment. The decision to refer for cataract surgery is based on the impact on vision and quality of life, not solely on visual acuity thresholds. Patients should be informed about the nature of cataracts, the effects on vision, and the risks and benefits of surgery before referral.

For children, urgent referral to a paediatric ophthalmologist is warranted if cataract is suspected based on red reflex examination findings.

These clinical features and referral criteria align with NICE guidelines and local CCG protocols for cataract management and referral pathways.