Cataract surgery is among the most commonly performed operations in the UK, and among the most litigated in ophthalmology. When a claim arises, the question is seldom whether the operation was technically competent. Far more often it turns on the conversation that came before it, and on whether the record can show that conversation happened.
What Montgomery actually requires
Since Montgomery v Lanarkshire (2015), the legal test for consent is no longer what a reasonable body of doctors would disclose. It is what a reasonable patient in the claimant's position would want to know, together with anything this particular patient would attach significance to. In cataract surgery that means the material risks, the realistic alternatives, and the things that matter to this patient's life and expectations, discussed and recorded, not simply listed on a leaflet.
A signature confirms that a patient agreed at one moment. It says nothing about whether the risks were explained in terms this patient could weigh.
Where cataract consent is tested
Three areas recur when I am instructed. First, refractive expectation: was the patient's target refraction discussed, and were the consequences of a refractive surprise, including anisometropia and the possible need for further correction, made clear? Second, alternatives: was continued spectacle correction, or deferral, genuinely offered and considered, or was surgery presented as the only option? Third, the material risks specific to this eye, including posterior capsule rupture, endophthalmitis, and the realistic prospect of a second procedure.
The documentation that defends
A defensible cataract consent is a contemporaneous account of a dialogue: the patient's stated priorities, the risks discussed in their own terms, the alternatives weighed, and the time given to decide. When the record shows that, a claim struggles. When it shows a generic risk sheet and a signature, the negotiation begins at the clinician's expense.
What solicitors should look for
On instruction, I examine the consent record against the standard the court will actually apply, not the standard the clinic assumed. The strongest cases, on either side, are decided by what the notes reveal about the conversation, or by their silence. Where the record is thin, causation frequently becomes the battleground: would this patient, properly informed, have proceeded, deferred, or chosen differently?
This commentary is general in nature and does not constitute legal or clinical advice on any specific case.
Frequently asked questions
What does Montgomery require for consent in cataract surgery?
Since Montgomery v Lanarkshire (2015), the test is no longer what a reasonable body of doctors would disclose. It is what a reasonable patient in the claimant's position would want to know, together with anything this particular patient would attach significance to. In cataract surgery that means the material risks, the realistic alternatives, and the things that matter to this patient's life, discussed and recorded, not simply listed on a leaflet.
Where is cataract consent most often tested in litigation?
Three areas recur: refractive expectation, including whether the target refraction and the consequences of a refractive surprise such as anisometropia were made clear; alternatives, including whether continued spectacle correction or deferral was genuinely offered; and the material risks specific to the eye, including posterior capsule rupture, endophthalmitis, and the realistic prospect of a second procedure.
Why is documentation so important in cataract consent claims?
A defensible cataract consent is a contemporaneous account of a dialogue: the patient's stated priorities, the risks discussed in their own terms, the alternatives weighed, and the time given to decide. When the record shows that, a claim struggles. When it shows a generic risk sheet and a signature, causation frequently becomes the battleground.