Changes

March 2025 — reviewed. A literature search was conducted in March 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomised controlled trials published since the last revision of this topic. There have been no major changes to the recommendations.

Update

Goals

To support primary healthcare professionals to:

• Make a diagnosis of cataracts.
• Appropriately refer the person with a cataract to an ophthalmologist for management.

Outcome measures

Audit criteria

QOF indicators

QIPP - Options for local implementation

NICE quality standards

Serious eye disorders

• Adults with cataracts are not refused surgery based on visual acuity alone.
• Adults with serious eye disorders are given a certificate of vision impairment as soon as they are eligible.

[NICE, 2019]

What is it?

A cataract is the opacification of the crystalline lens that affects vision. Most cataracts are related to ageing, and they can form in one or both eyes. 

Cataracts may be classified by:

• Clinical features and anatomy. The most common types are nuclear, cortical, and posterior sub-capsular (opacification of the nucleus, cortex and posterior aspect of the lens, respectively). Other types include anterior sub-capsular, cerulean, snowflake, sunflower, Christmas tree, oil droplet, traumatic, and posterior and anterior polar cataracts. Each type is associated with its own anatomical location, pathology, risk factors and typical symptoms.
• Age of onset.
  • Acquired (usually multifactorial as part of the normal ageing process; other contributory factors include trauma, metabolic disease, medication, UV radiation and other ophthalmological conditions).
  • Congenital.  Cataracts that occur in children may also be classified as: 
    • Congenital — if present at birth or within the first year of life.
    • Developmental — if they develop after infancy.
    • Traumatic.

[Medsinge, 2015; Miller, 2022; Cicinelli, 2023; BMJ Best Practice, 2024]

What causes cataracts?

• The cause for most cataracts is thought to be multifactorial. Ageing and oxidative stress (increased oxygen around the lens) are thought to be the primary causes. With age, changes in the lens proteins occur and affect how the lens functions and consequently visual acuity. Pathogenesis may be different for different types of cataract.
• Other potential contributing or causative factors include:
  • Trauma — cataract may develop after a blunt or penetrating injury to an eye, an electric shock, exposure to radiation, and as a complication of some surgical eye operations. Trauma is the most common cause of unilateral cataract in young people.
  • Ocular conditions such as myopia, uveitis and hereditary vitreopathies.
  • Systemic disease such as diabetes, hypertension and obesity.  Compared with the general population, there is about a 2-fold increased prevalence of cataract in people with diabetes mellitus. The risk is highest at younger ages, in people with macular oedema, and in people with long-standing diabetes.
  • Certain metabolic or hereditary conditions, such as Wilson's disease, galactosaemia, myotonic dystrophy, Marfan syndrome, Down syndrome, and neurofibromatosis type 2.
  • Systemic corticosteroid use.
  • Exposure to ultraviolet (UV) radiation.
  • Smoking and excessive alcohol use.
  • Genetic factors.
• Causes of congenital and developmental cataracts in children:
  • Unilateral cataracts — are usually idiopathic. Most of them are non-hereditary, without any systemic associations, and the child is usually otherwise well. 
  • Bilateral cataracts — many are idiopathic but a cause is identified in about 40% of affected children. Causes include: 
    • Hereditary cataracts that are often inherited in an autosomal dominant pattern but sometimes in an autosomal recessive, or X-linked fashion.
    • Intrauterine infections, such as rubella, varicella, cytomegalovirus, herpes simplex, and toxoplasmosis.
    • Genetic syndromes, such as Down's syndrome (trisomy 21), Edward's syndrome (trisomy 18), and Marfan syndrome.
    • Metabolic conditions, such as galactosaemia, Lowe syndrome, mannosidosis, Wilson's disease.

   [Medsinge, 2015; Becker, 2018; Miller, 2022; Cicinelli, 2023; BMJ Best Practice, 2024]

What are the risk factors?

Risk factors associated with the development of cataracts include:

• Age. Risk increases over the age of 60.
• Female gender. Women are at greater risk of cataracts than men.
• Diabetes mellitus doubles the risk.
• Hypertension.
• Obesity.
• Family history.
• Myopia.
• Trauma to the eye.
• Corticosteroid use (systemic, inhaled, topical and intravitreal).
• Ultraviolet B (UV-B) light exposure.
• Smoking.
• Certain metabolic and hereditary conditions (such as galactosaemia, Wilson's disease, Marfan syndrome, Down's syndrome, myotonic dystrophy, neurofibromatosis type 2).
• Regular excessive alcohol use.

Risk factors to be aware of when screening babies for cataracts as part of the NHS newborn and infant physical examination (NIPE) programme include:

• Family history of an eye condition with onset in infancy or early childhood.
  • Babies with a family history of bilateral congenital or hereditary cataracts in a first-degree relative are at risk of developing early cataracts. One-fifth of affected babies have a family history.
• Genetic syndromes.
• Pre-natal infection.
• Sensorineural hearing loss.
• Neurodevelopmental issues.

   [Becker, 2018; Miller, 2022; Cicinelli, 2023; BMJ Best Practice, 2024; NHS England, 2025]

How common is it?

• Cataract surgery is the most common surgical procedure undertaken in the NHS, and the annual cost to the NHS of cataract surgery is estimated at 600 million pounds [NOD, 2024]. In the financial year ending 2023, there were over 516,073 people over the age of 65 admitted to hospital for cataract surgery in England [OHID, 2024].
• The Way Forward report by the Royal College of Ophthalmologists in 2017 estimated there could be an increase of around 50% in the numbers of cataract operations needed over the 20 years between 2015 and 2035, largely due to the changing population demographics [RCOphth, 2017].
• A UK study that randomly sampled 1547 people 65 years of age and older found that the prevalence of visually-impairing cataracts was [Reidy, 1998]: 
  • 71% in people aged over 85 years. 
  • 59% in people aged 80–84 years.
  • 42% in people aged 75–79 years.
  • 24% in people aged 70–74 years.
  • 16% in people aged 65–69 years.
• Globally, cataract is the leading cause of blindness, and in 2020 it was estimated that 17 million people were blind, and 83.5 million had moderate to severe visual impairment due to cataract [Vision Loss Expert Group of the Global Burden of Disease Study, 2024].
  • Despite global progress in increasing access to cataract surgery and reducing avoidable visual impairment, population growth and ageing have begun to outstrip capacity, and cataract-related blindness rates have started to increase once more.
  • The highest proportions of cataract-related blindness are in Asia and Oceania, where cataracts accounts to 41 to 53% of blindness, whereas in high income countries with better access to surgical treatment, around 17% of blindness is caused by cataracts.
• A systematic review and meta-analysis of the regional and global prevalence of age-related cataracts found that the age-standardised pooled prevalence estimate (ASPPE) of any cataract was 17.2% and the pooled prevalence estimate (PPE) of any cataract in people aged [Hashemi, 2020]:  
  • 20–39 years was 3.01%.
  • 40–59 years was 16.97%.
  • Over 60 years was 54.38%.
• Cataracts in children are much less common.
  • In the UK about 2 to 3 in every 10,000 babies are born with cataracts, and in over half of those, both eyes are affected [NHS England, 2025]. Cataract is the most common treatable cause of blindness in childhood.
  • An observational study in the UK found that [Rahi, 2001]: 
    • About 3 in 10,000 children were diagnosed with cataract by the age of 1 year (two-thirds had bilateral cataracts, one-third had a unilateral cataract).
    • This increased to 4 in 10,000 children by 15 years of age.
  • Global epidemiological studies of paediatric cataract show gaps in data, but cataract is a leading cause of avoidable childhood blindness, and overall global prevalence of congenital cataract is estimated to be 0.63 to 9.74 per 10,000 children, and 0.32 to 22.9 per 10,0000 for childhood cataract [Sheeladevi, 2016].

What is the prognosis?

• Adults
  • Without treatment — with age-related cataracts, once visual acuity starts declining, the natural history is a steady decline without any chance of recovery. However, the rate and severity of progression is variable and unpredictable [Miller, 2022].  
    • Worldwide, many people do not have access to cataract surgery and in some parts of the world cataracts are responsible for up to 51% of blindness.
  • With surgery, the majority achieve significantly improved vision, and other benefits include improved quality of life, and reduced risk of depression, falls and fractures.
    • Around 95% of people will have 6/12 best-corrected vision post-operatively if there is no pre-existing ocular pathology, and up to 61% will have 6/6 best-corrected vision [Miller, 2022].
    • Fewer than one in 200 patients will have a reduction in vision following cataract surgery in England and Wales [NOD, 2024].
  • For people with bilateral cataracts, small but significant extra gains in visual function can be expected after surgery on the second eye, particularly in improved stereopsis (perception of depth of vision), if cataracts are removed from both eyes rather than just one [Frampton, 2014]. 
• Children
  • Without treatment — cataracts in young children cause deprivation amblyopia, leading to serious lifelong visual impairment, even if the cataracts are removed when older [Medsinge, 2015]. Worldwide, untreated childhood cataract is one of the major causes of preventable childhood blindness. 
  • With surgery — prognosis can be unpredictable and varied:
    
    • For congenital cataracts, a critical period for visual development is thought to occur in the first 6 weeks of life [Medsinge, 2015], but performing congenital cataract surgery during infancy is associated with a 15–30% risk of developing glaucoma [Lambert, 2016]. To optimise prognosis, it is thought that unilateral congenital cataracts should be removed by 4–6 weeks of life and bilateral congenital cataracts within the first 6–8 weeks of life with the aim of preventing the development of irreversible deprivation amblyopia, strabismus and nystagmus [Medsinge, 2015; Self, 2020].
    • Later ocular problems affecting children who have had cataract surgery include amblyopia, glaucoma, refractive errors, significant asymmetry in refraction between the eyes, strabismus (crossed eyes), retinal detachment and the need for further surgery [Repka, 2019].
    • A main factor in eventual visual outcome is compliance with treatment after surgery to prevent amblyopia (such as eye patching) [Medsinge, 2015]. 
    • Factors that may help predict postoperative visual outcomes include age at the time of cataract extraction, method of postoperative optical correction, the presence of nystagmus, and other ocular and systemic co-morbidity [Bonaparte, 2016].  

How should I diagnose a cataract in an adult?

Diagnosis of a cataract is made on the basis of typical symptoms and findings on examination. Many cataracts are diagnosed and monitored during routine optometrist appointments in the UK.

• The main symptom of cataract is a gradual and painless reduction in visual clarity and sharpness, affecting ability to do daily activities such as reading or driving. People with cataracts may experience:
  • Reduced acuity. Near or distance vision may be more affected, depending on the type of cataract. Vision may be described as cloudy or blurry.
  • Halos around lights, and sensitivity to bright light and glare (which may cause difficulties driving at night due to glare from oncoming headlights).
  • Diplopia (double vision) or polyopia (multiple images), usually in a single eye.
  • Frequent changes of spectacle prescription as a result of cataracts developing. 
  • Gradual reduction in perception of colour intensity (especially blues). 
• On examination (usually carried out by an optometrist as the relevant equipment and expertise is not usually available in GP practices):
  • The red reflex is absent, dull, or shadowed.
  • Visual acuity is usually reduced (measured with a Snellen chart).
  • On ophthalmoscopy and slit-lamp examination, opacity of the lens will be visible.

How should I assess an adult with cataracts?

Ask:

• About the person's symptoms and how they impact on the person's life and ability to function. Enquire about any impact on:
  • Ability to read or watch television.
  • Ability to drive, both in the day and at night.
  • Ability to work. (Consider occupation, for example, people who do fine work, or drivers of large vehicles who need to meet enhanced driving standards).
  • Their colour perception.
  • Their ability to recognise faces.
  • Mood and quality of life.
• Whether one or both eyes are affected.
• Whether visual loss has been gradual or sudden.
• Whether they would wish to have surgery to remove the cataract if offered (having had a discussion on what cataract surgery involves, and the risks and benefits associated with that procedure).
• About risk factors for cataracts, including family history, other ocular or systemic conditions, medication, and smoking.

Examine (usually by an optometrist):

• Visual acuity (using a Snellen chart).
• External eye examination
• Fundoscopy with an ophthalmoscope and slit lamp.
• Assessment of pupil size and function.
• Visual field assessment.
• Glare testing.
• Measurement of intraocular pressure.

How should I diagnose a cataract in a baby or child?

• In the UK, all babies are screened for congenital cataracts at birth (as part of the physical examination of newborn babies) and again when they are 6–8 weeks of age. See the section on Assessment - child for details regarding how to perform this screen.
• The effectiveness of this screening programme is variable, with cataracts being missed in over half of cases.  Therefore, any subsequent concern from a parent or guardian about the eyes or vision in an infant or child should be taken seriously, and the eyes examined again.
• When cataracts are not picked up at initial screening, they may be diagnosed when parents or carers raise concerns about possible symptoms/features of cataract, such as:
  • Not tracking moving objects visually.
  • Not being able to fix steadily on faces.
  • Apparent deterioration in, or lack of, visual interest.
  • Consistent eye misalignment.
  • Asymmetry of eye opening or inability to fully open the eyes.
  • Wobbling of the eyes.
  • Asymmetry of the white or red reflex seen on photos taken with a flash.
  • Behavioural changes such as inability to catch objects, frequent falls, or light sensitivity.
• If concerns are raised about vision, diagnosis is further progressed by examination:
  • Absent or abnormal red reflex. Congenital cataracts may cause a central shadow, completely obscure the red reflex, or make it seem dull in comparison to the other eye. With a severe cataract, the pupil may appear white when viewed with the naked eye.
  • There may be strabismus (squint or 'crossed' eyes) or nystagmus, particularly in later presentations.
  • Visual acuity testing and further ophthalmological examination by an optometrist or ophthalmologist.

How should I assess a baby or child for cataracts?

The NHS England Newborn and Infant Physical Examination (NIPE) programme handbook advises a screening examination of the eyes should take place within 72 hours of birth and at 6 to 8 weeks of age, using the following format.

• Explain the screening test and gain consent.
• At the newborn and 6 to 8-week infant checks, ask:
• • About the mother's recent obstetric history.
  • About any risk factors for eye disorders, including:
    • Family history of bilateral congenital or hereditary cataracts in a first-degree relative. (NB: consider specialist referral in these babies even if examination is normal.)
    • Family history (first-degree relative) of other ocular conditions which were present at birth or early childhood.
    • Prematurity.
    • Genetic syndromes associated with eye and vision disorders, such as Down syndrome.
    • Maternal exposure to viruses during pregnancy, including rubella and cytomegalovirus.
    • Neurodevelopmental conditions or sensorineural hearing loss.
• In addition, at the 6 to 8-week infant check, ask:
• • If the parents or carers have any concerns about the baby's visual behaviour. 
  • Ask if the baby can look at them steadily and whether they have started to smile at them.
  • If the baby can follow a bright moving object with their eyes.
  • Whether they have noticed any consistent deviation of either eye.
• Examine the eyes:
• • Examine the eyelids to exclude malformation and skin abnormality, including extensive port wine stain involving the eyelids, which can cause glaucoma and affect the baby's ability to fully open the eyelids.
  • Examine for symmetry of the eyes, and cornea (including clarity of the cornea).
  • Assess whether the baby can fixate on the face of the person examining, without nystagmus (6 to 8-week check).
  • Assess the baby's ability to fix and follow a large bright object by moving their eyes (6 to 8-week check).
  • Assess the red reflex. The red reflex is the normal reflection of white light from the back of the eye, which is usually seen as a red glow in the pupil on ophthalmoscopy, looking like the red-eye effect in a photo taken with a flash.
    • Dim the overhead lights.
    • Hold the eyepiece of the ophthalmoscope up to your eye, at arm's length from the baby's face.
    • Direct the circle of light from the ophthalmoscope towards the baby's eye (while gently parting the baby's eyelids if necessary).
    • View the red reflex through the ophthalmoscope eyepiece (colour, brightness and any shadows within it) in each eye.
    • The red reflex is abnormal if it is completely or partially obscured, abnormal in shape, white, or asymmetrical in colour or brightness when compared to the other eye.
    • Images of normal and abnormal red reflexes can be found on the NIPE handbook web page.

If parental concerns are raised later on in childhood, assess in a similar way, taking into account the age of the baby or child.

• Ask about risk factors as above.
• In addition, ask about symptoms or changes in vision-related behaviour.
• Ask about developmental history and achievement of milestones.
• Examine the eyes externally, as above.
• Assess the red reflex.
• Arrange for further eye examination with an optometrist or ophthalmologist, depending on initial findings.

What else might it be?

• Other causes of gradual visual disturbance include:
  • Refractive error — vision improves with a correct spectacle prescription. 
  • Corneal disease — various disorders can cause gradual loss of the corneal endothelial cells and increasing oedema of the cornea (for example, Fuchs' endothelial dystrophy). 
  • Dry eye — there may be an abnormal tear film. For more information, see the CKS topic on Dry eye syndrome.  
  • Presbyopia — this usually develops as a result of ageing (in the late forties). 
  • Age-related macular degeneration — for more information, see the CKS topic on Macular degeneration - age-related.
  • Infection or inflammation — symptoms and signs are specific to the individual diagnosis.
  • Macular oedema — blurred or distorted vision. 
  • Primary open-angle glaucoma — central visual field loss occurs late in the course of the disease. For more information, see the CKS topic on Glaucoma. 
  • Chemicals or drugs — for example, methanol, chloroquine, hydroxychloroquine, isoniazid, thioridazine, isotretinoin, tetracycline, and ethambutol.
  • Optic neuritis – decreased or patchy vision in one eye, pain on eye movement, or decreased colour vision. This is often associated with multiple sclerosis. For more information, see the CKS topic on Multiple sclerosis.
  • Pituitary tumour and papilloedema.
  • Diabetic eye disease — may present with visual loss, fluctuating vision, floaters, flashes of light, or field defects.
  • Retinoblastoma — rare cancer of childhood, with around 50 cases annually in the UK. Presentation is within the first year of life in bilateral cases and around 2 years of age if the tumour is unilateral. Leukocoria is the most common presentation (white-appearing pupil instead of normal red reflex), followed by strabismus. For more information, see the CKS topic on Childhood cancers - recognition and referral.
  • Epiretinal membrane — distorted or wavy vision, monocular diplopia, and aniseikonia (difference in image size as perceived between the two eyes).
• The following conditions may cause more rapid visual loss:
  • Cerebrovascular disease, including amaurosis fugax, transient ischaemic attack, and stroke. For more information, see the CKS topic on Stroke and TIA.
  • Posterior vitreous detachment, vitreous haemorrhage, or retinal detachment (usually present with floaters or flashing lights). For more information, see the CKS topic on Retinal detachment.
  • Retinal vein thromboses.
  • Retinal artery occlusions.

Scenario: Management of cataracts in adults

From age 18 years onwards.

Scenario: Management of cataracts in children

From birth to 18 years.

Search strategy

Scope of search

A literature search was conducted for guidelines and systematic reviews on primary care management of cataracts.

Search dates

February 2020 - March 2025

Key search terms

The terms listed below are the core search terms that were used for EBSCOhost MEDLINE (searched 24th February 2020). These were combined with filters to identify guidelines, systematic reviews and primary care relevant literature in EBSCOhost MEDLINE. The strategy was adapted for The Cochrane Library databases. 

S4    S1 OR S2 OR S3 
S3    AB lens opaci* OR TI lens opaci* 
S2    AB cataract* OR TI cataract* 
S1    (MH "Cataract+") 

Sources of guidelines

• National Institute for Health and Care Excellence (NICE)
• Scottish Intercollegiate Guidelines Network (SIGN)
• Royal College of Physicians
• Royal College of General Practitioners
• Royal College of Nursing
• NICE Evidence
• World Health Organization
• Guidelines International Network
• TRIP database
• Agency for Healthcare Research and Quality
• Institute for Clinical Systems Improvement
• National Health and Medical Research Council (Australia)
• Royal Australian College of General Practitioners
• British Columbia Medical Association
• Canadian Medical Association
• Alberta Medical Association
• Michigan Quality Improvement Consortium
• Singapore Ministry of Health
• National Resource for Infection Control
• RefHELP NHS Lothian Referral Guidelines
• Medline (with guideline filter)
• Driver and Vehicle Licensing Agency
• NHS Health at Work (occupational health practice)

Sources of systematic reviews and meta-analyses

• The Cochrane Library:
  • Systematic reviews
  • Protocols
  • Database of Abstracts of Reviews of Effects
• Medline (with systematic review filter)
• EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

• NIHR Health Technology Assessment programme
• The Cochrane Library:
  • NHS Economic Evaluations
  • Health Technology Assessments
• Canadian Agency for Drugs and Technologies in Health
• International Network of Agencies for Health Technology Assessment

Sources of randomized controlled trials

• The Cochrane Library:
  • Central Register of Controlled Trials
• Medline (with randomized controlled trial filter)
• EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

• Bandolier
• Drug and Therapeutics Bulletin
• TRIP database
• Central Services Agency COMPASS Therapeutic Notes

Sources of national policy

• Department of Health
• Health Management Information Consortium (HMIC)

Patient experiences

• Healthtalk
• BMJ - Patient Journeys

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

• British National Formulary (BNF)
• electronic Medicines Compendium (eMC)
• European Medicines Agency (EMEA)
• LactMed
• Medicines and Healthcare products Regulatory Agency (MHRA)
• REPROTOX
• Scottish Medicines Consortium
• Stockley's Drug Interactions
• TERIS
• TOXBASE
• Micromedex
• UK Medicines Information

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

• Clinical accuracy.
• Consistency with other providers of clinical knowledge for primary care.
• Accuracy of implementation of national guidance (in particular NICE guidelines).
• Usability.

Principles of the consultation process

• The process is inclusive and any individual may participate.
• To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
• Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website.
• Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
• External reviewers are not paid for commenting on the draft topics.
• Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
• All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
• All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

Stakeholders

• Key stakeholders identified by the CKS team are invited to comment on draft CKS topics. Individuals and organizations can also register an interest to feedback on a specific topic, or topics in a particular clinical area, through the Getting involved section of the Clarity Informatics website.
• Stakeholders identified from the following groups are invited to review draft topics:
  • Experts in the topic area.
  • Professional organizations and societies (for example, Royal Colleges).
  • Patient organizations, Clarity has established close links with groups such as Age UK and the Alzheimer’s Society specifically for their input into new topic development, review of current topic content, and advice on relevant areas of expert knowledge.
  • Guideline development groups where the topic is an implementation of a guideline.
  • The British National Formulary team.
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• Reviewers are provided with clear instructions about what to review, what comments are particularly helpful, how to submit comments, and declaring interests.

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Clarity Informatics has enlisted the support and involvement of patients and lay persons at all stages in the process of creating the content which include:

• Topic selection
• Scoping of topic
• Selection of clinical scenarios
• First draft internal review
• Second draft internal review
• External review
• Final draft and pre-publication

Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

• Animal studies
• Original research is not written in English

Possible exclusions for reviewed literature:

• Sample size too small or study underpowered
• Bias evident or promotional literature
• Population not relevant
• Intervention/treatment not relevant
• Outcomes not relevant
• Outcomes have no clear evidence of clinical effectiveness
• Setting not relevant
• Not relevant to UK
• Incorrect study type
• Review article
• Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

• Feasibility
  • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
• Organizational and Financial Impact Analysis
• Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
  • Eligible population
  • Current interventions
  • Likely uptake of new intervention or recommendation
  • Cost of the current or new intervention mix
  • Impact on other costs
  • Condition-related costs
  • In-direct costs and service impacts
  • Time dependencies
• Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

• Personal financial interests
• Personal family interest
• Personal non-financial interest
• Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

Who should declare competing interests?

Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.