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Equity of access is a fundamental guiding principle of the NHS. However, the resources of the NHS are finite and, acknowledging that commissioning bodies have to make difficult choices with limited budgets, we have reviewed the available evidence to try to answer some basic questions about cataract and its treatment, such as:

  • Who is at risk of developing cataract?
  • How does cataract affect health?
  • Is cataract surgery effective?
  • At what level of disability should cataract surgery be considered?
  • Is one good eye good enough?
  • What outcomes should be expected from cataract surgery?
  • How can the risks of cataract surgery be minimised?
  • How should cataract services care for patients with special needs?
Guidance Description
Cataract Commissioning Guide – 2018


This document was originally written in response to emerging evidence of wide geographical variation in access to cataract surgery in England. Overall 9 in every 10 cataract surgery commissioning policies contained criteria that followed “neither national guidance nor scientific evidence.” It has been revised following the publication of The National Institute of Health and Care Excellence (NICE) ‘Cataracts in adults: management’. Following detailed health economic modelling, a key recommendation of this guideline is that arbitrary thresholds of visual acuity should not be used to restrict access to cataract surgery.

Cataract Commissioning Guide January 2018 aims to provide evidence-based guidance to support the commissioning of high quality cataract services and to promote equity of access to the treatment of visual impairment caused by cataract.

SAFE – Cataract – 2017 Developed by the Clinical Council for Eye Health Commissioning (CCEHC), SAFE (Systems and Assurance Framework for Eye health) provides the tools to help commissioners in developing a more strategic and consistent approach to planning and delivering services.

This SAFE documents focuses on Cataract services.

Other documents:

Elective care report – FINAL – Monitor edit v11
New to follow up ratios in ophthalmology outpatient services
Don’t turn back the clock: Cataract Surgery – the need for patient-centred care
Quality Standards for Cataract Services

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