What is the recommended preoperative medical assessment for patients undergoing cataract surgery?

Preoperative Medical Assessment for Cataract Surgery

Routine preoperative medical testing is not indicated for most patients undergoing cataract surgery and does not reduce perioperative complications. 1

General Approach

Cataract surgery is considered an extremely low-risk procedure with minimal risk of adverse outcomes. The evidence strongly supports a targeted approach to preoperative assessment rather than routine testing.

Key Points:

• Cataract surgery is classified as a low-risk procedure
• Only 0.1-0.5% of preoperative tests result in changes to perioperative management 1
• A large randomized controlled trial of over 19,000 patients showed no difference in outcomes between patients who received preoperative testing and those who did not 2

Recommended Assessment Algorithm

1. Medical History Review

   • Focus on conditions that may affect:
     • Ability to cooperate during surgery
     • Ability to position appropriately
     • Ability to follow postoperative care instructions
   • Identify patients with:
     • Poorly controlled chronic conditions (COPD, hypertension, diabetes)
     • Recent myocardial infarction or unstable angina
     • Poorly controlled congestive heart failure 1

2. Medication Review

   • Identify medications that could cause pupil dilation and induce angle closure (anticholinergics)
   • Review anticoagulant use (no routine testing needed, but important to note) 1

3. Practical Considerations

   • Evaluate patient's ability to attend follow-up visits
   • Assess ability to administer postoperative medications
   • Identify available caregiver support if needed 1
   • Address communication barriers (language, hearing impairment)

Selective Testing Guidelines

Do not order routine preoperative laboratory tests. Instead, follow these selective testing guidelines:

Test	Indication
ECG	Only for patients with cardiovascular risk factors undergoing general anesthesia (rare for cataract surgery)
Electrolytes/Creatinine	Only for patients with CKD stage 3a or higher
CBC	Only for patients with CKD or history suggesting anemia, if no recent results available
Chest X-ray	Only for patients with new or unstable cardiopulmonary symptoms
Coagulation studies	Only for patients on anticoagulants or with history of bleeding disorders
Urinalysis	Only for patients with specific urologic symptoms or undergoing implantation of foreign material
Blood glucose/A1C	Only if abnormal result would change perioperative management [2,1]

Special Considerations

Hypertension Management

• While hypertension is common (occurring in up to 33% of cataract surgery patients), studies show that even patients with initial systolic pressure ≥180 mm Hg did not have higher risk of surgical complications 3
• Preoperative evaluation has been shown to result in lower hypertension rates during surgery 3

Ocular-Specific Assessment

• Preoperative dry eye disease should be identified and treated before surgery
• Consider postponing surgery if visually significant ocular surface disease is detected 1

Common Pitfalls to Avoid

1. Overtesting: Routine testing adds cost and burden without improving outcomes 4
2. Unnecessary delays: Requiring extensive preoperative testing can delay surgery without benefit
3. Ignoring patient education: Patients most want to know benefits and risks of surgery, including very small risks 5
4. Overlooking practical barriers: Failing to assess patient's ability to follow postoperative care instructions

By following these evidence-based guidelines, clinicians can ensure appropriate preoperative assessment for cataract surgery patients while avoiding unnecessary testing and delays.