What are the preoperative clearance requirements for cataract surgery?

Preoperative Clearance Requirements for Cataract Surgery

Routine preoperative medical testing and general medical clearance are not indicated for most cataract surgery patients, as multiple randomized clinical trials have shown they do not reduce perioperative morbidity or mortality. 1

General Preoperative Assessment

• The operating ophthalmologist should perform the preoperative assessment to establish a relationship with the patient and formulate a surgical plan 1
• Assessment should include:
  • Review of ocular history and comorbidities that may affect surgical planning 1
  • Evaluation of patient's mental and physical status, including ability to cooperate and position for surgery 1
  • Assessment of relevant barriers to communication (language, hearing impairment) 1

Medical Evaluation Guidelines

• Routine preoperative laboratory testing is not indicated for cataract surgery 1, 2
• A preoperative general medical history and physical examination is not beneficial for most cataract surgical patients beyond the screening performed by anesthesia staff on the day of surgery 2, 3
• Directed testing may be recommended only for specific surgical candidates with medical problems 1

Special Considerations for High-Risk Patients

• Preoperative medical evaluation by the patient's primary care physician should be considered only for patients with:
  • Chronic obstructive pulmonary disease 1
  • Poorly controlled arterial blood pressure 1
  • Recent myocardial infarction 1
  • Unstable angina 1
  • Poorly controlled congestive heart failure 1
  • Poorly controlled diabetes 1

Medication Management

• Patients do not need to discontinue anticoagulants for cataract surgery 4
• Special consideration for patients on alpha-1 antagonists (e.g., tamsulosin) due to risk of intraoperative floppy iris syndrome - some ophthalmologists temporarily discontinue these medications preoperatively 5, 4

Ocular-Specific Evaluation

• Optical biometry for intraocular lens power calculation is recommended over ultrasound techniques 1
• Assessment for concurrent upper-eyelid blepharoptosis, as it can induce corneal astigmatism or make astigmatism more difficult to measure 1
• Evaluation for dry eye disease, as patients with visually significant dry eye may require treatment before surgery 1

Patient Education and Consent

• Informed consent must include discussion of risks, benefits, and expected outcomes 1
• Patients most want to know about:
  • Chance of visual improvement
  • Timeline for vision improvement
  • Overall risk of losing vision
  • Effect of not having the operation
  • Types of serious complications 6
• Written information should be provided to reinforce verbal information (requested by 85.7% of patients) 6

Common Pitfalls to Avoid

• Relying solely on visual acuity to determine cataract impact - glare testing and contrast sensitivity provide additional valuable information 5
• Performing unnecessary routine medical testing that adds cost and patient burden without clinical value 2, 3
• Failing to rule out other causes of vision loss before attributing symptoms solely to cataracts 5

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