1. Purpose
Eye surgery is often elective and is chosen by the patient to improve vision, so the patient's understanding and agreement matter as much as the surgery itself. The law on consent expects a patient to be told about the material risks that matter to them and the reasonable alternatives, including doing nothing. This policy sets out how the Service takes informed consent for ophthalmic procedures, with realistic expectations about what vision the patient will have afterwards.
The Service must verify this policy against current GMC consent guidance, the Montgomery standard of material risk, and the Mental Capacity Act before adoption.
2. Sources to verify before adoption
- GMC, Decision making and consent: https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/decision-making-and-consent
- The Montgomery v Lanarkshire standard of material risk (verify the current legal position)
- Royal College of Ophthalmologists, procedure-specific consent and patient-information material: https://www.rcophth.ac.uk/
- Mental Capacity Act 2005: https://www.legislation.gov.uk/ukpga/2005/9/contents
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 11 (consent): https://www.legislation.gov.uk/uksi/2014/2936/regulation/11
3. Scope
This policy applies to:
- every ophthalmic procedure the Service offers, including cataract surgery, refractive and laser surgery, intravitreal injection and minor oculoplastic surgery
- the clinicians who take consent and the staff who support the process
- adults with capacity, adults who may lack capacity for the decision, and (where in scope) children
4. What the patient is told
For each procedure the patient is told, in plain language and in a form they can keep:
- what the procedure is and what it is for
- the realistic benefit, and that an improvement is not guaranteed
- the material risks, including those that matter to this particular patient given their eyes, occupation and lifestyle
- the reasonable alternatives, including glasses, contact lenses, watchful waiting or doing nothing, and the likely outcome of each
- what recovery involves and what restrictions apply afterwards
Risk information is procedure-specific. For example, cataract surgery covers the risk of posterior capsule rupture, endophthalmitis, retinal detachment, the chance the lens power is not exactly on target, and the likelihood of still needing glasses for some tasks. Intravitreal injection covers endophthalmitis and the need for urgent help if symptoms occur. The Service confirms its risk wording against current Royal College of Ophthalmologists material.
5. Realistic expectations about vision
Because patients choose eye surgery to see better, the Service is clear and honest about the visual result:
- the target refraction is explained, and whether the patient should still expect to wear glasses for distance, near or both
- where a particular lens choice (for example a multifocal or toric lens) carries trade-offs such as glare, haloes or reduced contrast, these are explained before the choice is made
- the patient is not given an expectation of perfect or spectacle-free vision unless that is a realistic outcome for them
6. Two-stage consent and time to decide
For elective and refractive procedures the Service separates the discussion from the day of surgery, so the patient has time to reflect:
- consent is discussed at an earlier consultation, the patient is given written information to take away, and consent is confirmed (not first taken) on the day
- the patient is told they can change their mind at any point up to the procedure, without pressure
- the Service does not rush a patient into an elective procedure on the same day as the first consultation
7. Capacity and best interests
Where a patient may lack the capacity to decide about a procedure, the Service follows the Mental Capacity Act: capacity is assessed for that decision, all practicable help is given to support the person to decide, and where they cannot, a best-interests decision is made and recorded, involving those close to the person and, where the person has no one to represent them, an independent advocate.
8. Chaperone and dignity
The patient is offered a chaperone for any examination or procedure where one is appropriate, the offer and the patient's choice are recorded, and the patient's dignity and comfort are respected throughout.
9. Recording
The consent discussion, the information given, the patient's questions, the agreed procedure and lens, and the patient's agreement are recorded. The signed consent form is one part of the record, not the whole of it; the record shows that a real discussion took place.
10. Audit cadence
The Service checks, on a stated cadence, that:
- consent records show procedure-specific risks, benefits and alternatives, not a generic form
- elective procedures had time between the consultation and the day of surgery
- capacity assessments and best-interests records are present where needed
- chaperone offers are recorded
The Registered Manager and the clinical lead review the results and record the improvement actions that follow.