Patient factors in determining the urgency of cataract referral

Patients with cataract experience various symptoms that reduce the quality of life. This study aims to investigate the characteristics of patients who were referred for urgent versus routine cataract surgery.

A 7-month retrospective study was performed on 140 patients referred by opticians for cataract surgery in the Princess Alexandra Eye Pavilion, UK. Basic demographic information, including the Scottish Index of Multiple Deprivation (SIMD), number of symptoms (nVFQ), visual acuity (VA), urgency of referral by the optometrist, and triage status by the doctor (urgent versus routine), was collected. Sub-group analysis of differences between routine and urgent cases was performed using a two-sample t-test or a Chi-squared test. Logistic regression was used to examine factors associated with an increased odds of urgent presentation. Parameters found to be significant on univariate regression analyses were further investigated using multivariable regression analyses.

Sub-group analysis showed that nVFQ was associated with triage status by doctors (p=0.01) and urgency of referral by optometrists (p<0.0001). VA was not associated with referral urgency or triage status. Univariate logistic regression demonstrated that the nVFQ is associated with triage status by doctors (OR=1.70, CI=1.11-2.60, p=0.014) and urgency of referral by optometrists (OR=2.22, CI=1.44-3.41, p=0.0003). ANOVA testing showed a significant association between SIMD quintile and nVFQ (p=0.036).

While visual acuity did not affect prioritisation, patients reporting more symptoms were more likely to receive urgent referrals. Symptom reporting increased with higher socioeconomic status, suggesting reliance on symptoms alone may disadvantage more deprived patients, who already face a higher cataract burden and poorer access to care. These findings align with NICE guidance prioritising lifestyle impact over visual acuity and highlight the need for improved patient education and standardised symptom assessment to promote equitable care.

Our study demonstrated an association between higher cataract symptom reporting, but not visual acuity, with urgency of referral and triage status. Lower socioeconomic deprivation was associated with higher reporting of cataract symptoms. Further research should explore the factors that contribute to the relationship between socioeconomic background and symptom reporting.