Preoperative Medical Evaluation for Cataract Surgery
Routine preoperative medical testing is not indicated for most cataract surgery patients and does not reduce perioperative complications. 1, 2, 3
Key Considerations for Preoperative Evaluation
Ophthalmic Assessment
- Complete ophthalmic examination by the operating ophthalmologist
- Documentation of visual symptoms and functional limitations
- Assessment of potential for visual improvement
- Evaluation of ocular comorbidities that may affect surgical outcomes
- Identification and treatment of preoperative dry eye disease before surgery 2
Medical Evaluation
- For most patients, no routine preoperative laboratory testing is required 1, 2
- Three randomized clinical trials have demonstrated that routine medical testing does not reduce perioperative complications 1, 3, 4
- Only 0.1-0.5% of preoperative tests result in changes to perioperative management 2
Targeted Medical Evaluation
Medical evaluation should be considered only for patients with:
- Chronic obstructive pulmonary disease
- Poorly controlled hypertension
- Recent myocardial infarction
- Unstable angina
- Poorly controlled congestive heart failure
- Poorly controlled diabetes 1, 2
Specific Testing Indications
| Test | Indication |
|---|---|
| Electrolyte and creatinine | CKD stage 3a or higher |
| ECG | Cardiovascular risk factors undergoing general anesthesia |
| CBC | CKD with no recent results |
| Chest radiography | New or unstable cardiopulmonary symptoms |
| Thyroid function tests | Active thyroid dysfunction or recent medication changes |
| Coagulation studies | Specific symptoms warranting evaluation [2] |
Patient-Specific Factors to Assess
- Mental and physical status affecting ability to cooperate during surgery
- Ability to position appropriately for the procedure
- Communication barriers (language, hearing impairment)
- Ability to attend follow-up visits and administer medications
- Available caregiver support 1, 2
Perioperative Risk Considerations
- Cataract surgery poses minimal systemic medical risk 5
- Hypertension is the most common perioperative event (33% of patients) 6
- Even high preoperative blood pressure (≥180 mmHg systolic) has not been associated with increased surgical complications 6
Common Pitfalls to Avoid
- Overtesting: Routine preoperative testing adds cost and patient burden without improving outcomes 5
- Inadequate patient education: Patients most want to know about benefits, risks (even very small ones), and expected visual improvement 7
- Delayed surgery: Unnecessary preoperative evaluations can significantly increase waiting time for surgery 6
- Failure to provide written information: 85.7% of patients request written information to reinforce verbal discussions 7
Informed Consent Priorities
Patients particularly value information about:
- Chance of visual improvement
- Timeline for vision improvement
- Overall risk of vision loss
- Consequences of not having surgery
- Types of serious complications 7
By focusing on targeted evaluation rather than routine testing, ophthalmologists can provide efficient, evidence-based preoperative care that prioritizes patient safety while avoiding unnecessary delays and costs.