From the Guidelines
Preoperative clearance for cataract surgery typically requires minimal testing for most patients, with a comprehensive history and physical examination by the primary care physician being sufficient, as supported by the most recent evidence from 2022 1. The focus of this examination should be on cardiovascular and pulmonary status, with laboratory tests generally not needed unless indicated by specific medical conditions.
- Patients should continue most of their regular medications, including blood pressure medications, on the day of surgery.
- Anticoagulants like warfarin may need adjustment based on surgeon preference, while newer anticoagulants (DOACs) often require temporary discontinuation 24-48 hours before surgery, as suggested by guidelines from 2013 1.
- Diabetic patients should adjust their morning insulin dose and skip oral hypoglycemics on the surgery day.
- Patients using alpha-blockers for prostate issues should inform their ophthalmologist due to potential intraoperative floppy iris syndrome.
- Preoperative antibiotic eye drops (typically fluoroquinolones like moxifloxacin) are often prescribed to start 1-3 days before surgery. This minimal approach to clearance is appropriate because cataract surgery is performed under local anesthesia with minimal sedation, has a short duration (typically 15-30 minutes), and carries very low systemic risk, making extensive preoperative testing unnecessary for most patients, as confirmed by the 2022 preferred practice pattern for cataract in the adult eye 1. Key aspects of preoperative evaluation and counseling, as outlined in the 2022 guidelines 1, include:
- A thorough ophthalmic evaluation
- Informed consent discussing risks, benefits, and expected outcomes
- Review of presurgical evaluation results with the patient
- Counseling on postoperative refractive options and elective refractive options
- Consideration of ocular comorbidities and their impact on the cataract care process
- Formulation of a plan including preoperative medical management, selection of appropriate anesthesia, surgical approach, and postoperative care.
From the Research
Preoperative Clearance Requirements for Cataract Surgery
The preoperative clearance requirements for cataract (intraocular lens implantation) surgery involve several key considerations, including:
- A complete ocular history and physical examination 2
- Patient education 2
- Preoperative testing, such as keratometric readings, ultrasound axial length of the eye (A-scan), and a calculation of implant power requirements using a modern implant formula 2
- Informed consent 2
- Identification of high-risk factors, such as age, retinal diseases, advanced macular disease (AMD), hypoglycemic medications, and hemoglobin A1C (Hgb A1C) levels, particularly in diabetic patients 3
- Consideration of the patient's overall medical history, although a preoperative general medical history and physical may not be required for all patients 4
Special Considerations
Certain patient populations, such as those with diabetes or glaucoma, may require additional preoperative evaluation and planning, including:
- Assessment of retinal diseases and advanced macular disease (AMD) in diabetic patients 3
- Evaluation of intraocular pressure (IOP) and biometric characteristics in patients with glaucoma 5
- Consideration of combined cataract surgery with other procedures, such as trabeculectomy, in patients with glaucoma 5
Preoperative Testing
The necessary preoperative testing may vary depending on the individual patient's needs, but may include: