From the Guidelines
Preoperative evaluation for an elderly woman undergoing cataract surgery should be limited to a comprehensive medical history and physical examination, with no routine preoperative testing required, as evidenced by a large randomized controlled trial and reinforced by a 2012 Cochrane review 1.
Necessary Preoperative Evaluations
The focus of the preoperative evaluation should be on identifying and managing conditions that could increase surgical risk or affect postoperative outcomes. This includes:
- A comprehensive medical history, including current medications, allergies, and previous surgical experiences
- Assessment for conditions that may complicate surgery, such as diabetes, hypertension, heart disease, and pulmonary issues
- Review of the patient's mental and physical status, including cognitive function and ability to cooperate with surgery
Preoperative Testing
According to the most recent and highest quality study, no preoperative testing is required for patients undergoing cataract surgery who are in their usual state of health 1. However, if indicated by medical history, basic preoperative testing such as vital signs, ECG, and basic blood work may be considered.
Additional Considerations
- Topical antibiotics like moxifloxacin or gatifloxacin drops should be started 1-3 days before surgery to reduce infection risk
- The patient should be instructed to fast for 6 hours before surgery if receiving sedation, though clear liquids may be permitted up to 2 hours prior
- Cataract surgery is typically performed under topical anesthesia with minimal sedation, making it well-tolerated even in elderly patients with comorbidities
- Special attention should be paid to cognitive status, as patients with dementia may require additional support during the perioperative period to ensure compliance with instructions and postoperative care, as recommended by the 2022 guidelines 1
- The operating ophthalmologist should perform the preoperative assessment, or supervise trained team members, to formulate a plan and establish a relationship with the patient before surgery 1
From the Research
Preoperative Evaluations for Cataract Surgery
The necessary preoperative evaluations for an elderly woman undergoing cataract (intraocular lens implantation) surgery are minimal due to the low-risk nature of the procedure.
- Routine preoperative testing is typically not needed 2
- A preoperative general medical history and physical is required by regulatory bodies, but there is consensus that it confers no benefit for most cataract surgical patients 3
- Preoperative laboratory testing is also not beneficial when routinely performed on cataract surgical patients 3
Identification of High-Risk Patients
To identify high-risk patients, several preoperative screening tools can be applied, including:
- American Society of Anesthesiologists Physical Status (ASA-PS) 4
- Frailty tools 4
- Domain-specific tools administered as part of comprehensive geriatric assessment (CGA) 4
- Cognitive and/or functional tools 4
Teamwork and Comprehensive Preoperative Approach
Planning for cataract surgery and perioperative care in the very elderly requires the teamwork of the patient's primary care provider and the ophthalmologist 5 A comprehensive preoperative approach incorporating domain-specific tools is recommended by international guidelines 4