From the Guidelines
Preoperative clearance for cataract surgery typically requires a comprehensive eye examination, medical history review, and basic health assessment, with a focus on minimizing surgical risks and ensuring optimal outcomes by identifying potential complications before they occur. Patients should undergo a complete eye evaluation including visual acuity testing, intraocular pressure measurement, and dilated fundus examination to determine surgical candidacy and identify any ocular conditions that might affect outcomes 1. Medical clearance often involves a basic health questionnaire and, for patients with significant medical conditions, consultation with their primary care physician to ensure they can safely undergo the procedure.
- Laboratory tests are not routinely required for healthy patients but may include blood glucose levels for diabetics or coagulation studies for those on blood thinners, such as direct oral anticoagulants (DOACs), which may require interruption 2-3 days before surgery for low-to-moderate-bleed-risk procedures or 3-4 days for high-bleed-risk procedures or in patients with impaired renal function 1.
- Patients are usually instructed to continue most regular medications, including blood pressure and heart medications.
- Antibiotic eye drops such as moxifloxacin or gatifloxacin are typically started 1-3 days before surgery to reduce infection risk.
- Patients should disclose all medications, allergies, and previous surgical complications.
- The use of preservative-free eye-drop regimens is suggested for preventing the exacerbation of dry eye disease (DED) and the associated toxicity that damages the ocular surface, especially in high-risk patients 1.
- A dropless strategy, where applicable, can be considered to reduce the postoperative burden on the patient and improve surgical outcomes 1.
- Risk stratification for patients with DED should be performed to identify patients at low, moderate, or high risk of developing DED after cataract surgery and manage them accordingly 1.
From the Research
Preoperative Clearance Requirements for Cataract Surgery
The preoperative clearance requirements for cataract surgery are a topic of ongoing debate, with various studies suggesting that routine preoperative medical testing may not be necessary for all patients.
- A study published in 2019 2 found that routine preoperative medical testing did not reduce the risk of intraoperative or postoperative ocular adverse events in cataract surgery patients.
- Another study from 2017 3 proposed that a preoperative medical history and physical should not be a requirement for all cataract patients, as cataract surgery poses minimal systemic medical risk.
- A retrospective evaluation published in 2010 4 found that the main reasons for cancellation of elective cataract surgeries were poor control of systemic hypertension, cancellation by patient, and improper control of diabetes.
Essential Preoperative Testing
While routine preoperative medical testing may not be necessary, certain preoperative tests are essential for cataract surgery, including:
- Keratometric readings
- Ultrasound axial length of the eye (A-scan)
- Calculation of implant power requirements using a modern implant formula 5
- Corneal endothelial cell counts, corneal pachymetry, and B-scan ultrasonographic scanning of the posterior segment may be needed in some circumstances 5
Patient Evaluation
A thorough preoperative evaluation of the patient is crucial, including:
- Complete ocular history and physical examination
- Patient education
- Informed consent 5
- A study published in 2016 6 found that preoperative evaluation resulted in a lower hypertension rate after adjustment for propensity score, but did not affect the risk of posterior capsule rupture or postoperative adverse events.