Cataract F023

Current RMA Instruments

Changes from previous Instruments

ICD Coding

• ICD-10-AM Codes: H25.0, H25.1, H25.2, H25.8, H25.9, H26.1, H26.2, H26.3, H26.4, H26.8, H26.9, H28.1 or H28.2

Brief description

A cataract is a condition in which there is partial or complete opacification (clouding) of the lens or lens capsule of the eye, resulting in impaired vision. It may affect one or both eyes and typically develops gradually over time. 

Cataracts are a common cause of visual impairment, particularly in older individuals. For the purposes of this SOP, the diagnosis requires visual impairment attributable to the cataract. Early lens opacification without associated visual loss is not sufficient to meet the definition.

Confirming the diagnosis

The diagnosis is made clinically based on examination of the lens using an ophthalmoscope or slit lamp, and assessment of visual acuity. Confirmation and management of this diagnosis is undertaken by an optometrist or ophthalmologist. 

Additional diagnoses covered by the SOP

• Nuclear sclerosis/cataract
• Cortical cataract
• Posterior subscapular cataract

Conditions not covered by the SOP

• Congenital cataract - revoked SOP (cannot be related to service)
• Infantile cataract #
• Lens malformations #
• Early lens opacification without associated visual loss - not an injury or disease 

* another SOP applies - the SOP has the same name unless otherwise specified

# non-SOP condition

Clinical onset

Clinical onset generally corresponds to the time at which the diagnosis is first confirmed, with evidence of visual impairment due to cataract. Onset may be backdated where there is clear documentation of earlier visual symptoms that are attributable to cataract and not explained by another cause of visual impairment. 

Clinical worsening

Cataracts typically show slow progressive worsening over time. The rate of progression may vary between individuals. Clinical worsening may be indicated by declining visual acuity, increasing lens opacity, or a greater impact on daily activities. Treatment is usually surgical, involving removal of the cloudy lens and replacement with an artificial intraocular lens, which generally results in significant improvement in vision. 

Delayed access to appropriate treatment may result in increased surgical complexity and risk of complications, particularly in advanced cataracts, but does not alter the underlying progression of the condition.