Hospital and locum optometrist, LOC vice chairman and College Council Member, East Midlands 

I describe cataracts in various stages: mild, moderate and mature. In the early stages I use the analogy that the root of your hair is going grey or your skin is showing early signs of wrinkles; there’s still time for the cataract to mature and it’s probably not affecting your vision much. A moderate cataract is when there is a noticeable reduction in visual acuity (VA). A dense cataract is where there is a noticeable change in VA, myopic shift or cylinder change that borders on failing DVLA driving standards.

What may seem like an insignificant cataract may affect a patient hugely day-to-day. This also depends on how it is growing. If it’s affecting their job, daily activities or quality of life I would consider referring them despite not meeting a “VA threshold”.

I go through the risks and benefits with patients before referring. They make better choices when they understand this.