What visual acuity thresholds should I consider when assessing a patient for cataract-related referral?

Visual acuity thresholds for referral due to cataract:

• Do not restrict access to cataract surgery solely based on visual acuity, as per NICE guidance.
• However, some local Clinical Commissioning Groups (CCGs) have specific visual acuity criteria for supporting cataract surgery referrals:
• Monocular visual acuity of 6/18 or worse, regardless of the other eye's acuity.
• Binocular visual acuity of 6/12 or worse for non-drivers.
• Binocular visual acuity of 6/9 or worse for drivers.
• Referral may also be considered if the patient experiences significant quality of life impact or symptoms such as disabling glare or double vision, even if visual acuity is relatively unaffected.
• Drivers must meet the DVLA minimum sight requirements, which include being able to read a vehicle number plate at 20 metres with at least 6/12 visual acuity in both eyes or the better eye.

These thresholds are based on local commissioning policies such as Dorset CCG and Brighton and Hove CCG, alongside NICE recommendations that emphasise patient-centred decision making rather than strict acuity cut-offs ².