What are the next steps for a 59-year-old male patient scheduled for cataract extraction with intraocular lens implantation (CEIOL) in the left eye?

Next Steps for Cataract Extraction with Intraocular Lens Implantation

The operating ophthalmologist must perform a comprehensive preoperative evaluation, obtain informed consent after discussing risks and benefits, formulate a surgical plan including IOL selection, and arrange appropriate postoperative care before proceeding with the scheduled CEIOL. 1

Preoperative Evaluation Requirements

The ophthalmologist who will perform the surgery must complete the following essential steps before the procedure:

Clinical Assessment

• Perform a complete ophthalmic examination to document visual acuity, refraction, slit-lamp findings, intraocular pressure, and dilated fundus examination 1
• Verify that documented symptoms and findings accurately reflect the indication for surgery and that the cataract is the limiting factor for visual function 1
• Assess the patient's mental and physical status, specifically his ability to cooperate and position properly during surgery 1
• Evaluate for concurrent upper-eyelid blepharoptosis, as this can induce corneal astigmatism and may worsen after cataract surgery 1

Biometry and IOL Planning

• Perform biometry measurements to calculate appropriate IOL power for the desired refractive outcome 1
• Counsel the patient about postoperative refractive options including bilateral emmetropia, bilateral myopia, or monovision based on his visual needs and desires 1
• Discuss elective refractive options such as astigmatism management, specialty IOLs (toric, extended depth of focus, multifocal, accommodating), and potential postoperative refractive enhancement 1

Informed Consent Process

The surgeon must obtain informed consent after thoroughly discussing:

• Risks, benefits, and expected outcomes of the surgery including the anticipated surgical experience and refractive outcome 1
• The patient's expected visual improvement and how it will impact his daily activities 2
• Potential complications including posterior capsule rupture, iris prolapse, and the rare risk of endophthalmitis (0.02% with intraoperative antibiotics) 1, 3
• Associated costs, particularly if advanced technology IOLs are being considered, as these are not covered by medical insurance 3

Surgical Planning

Anesthesia and Medical Clearance

• Topical anesthesia is typically used for cataract surgery, eliminating the need for preoperative bloodwork or electrocardiogram 3
• Anticoagulants do not need to be discontinued for cataract surgery 3
• Review medications for α1-adrenergic antagonists (such as tamsulosin for benign prostatic hyperplasia), as these increase surgical complication risk and some surgeons temporarily discontinue them preoperatively 3

Surgical Technique Selection

• Phacoemulsification with foldable IOL implantation is the standard approach, producing better uncorrected distance visual acuity and lower complication rates compared to manual techniques 1, 2, 4
• Plan for intraoperative antibiotics (moxifloxacin or cefuroxime) to reduce endophthalmitis risk from 0.07% to 0.02% 3

Postoperative Care Arrangements

Care Planning

• Formulate a specific postoperative care plan including the setting of care and designated care provider 1
• Ensure the patient can attend all postoperative visits and address potential barriers including transportation and medication administration 1
• Prescribe topical anti-inflammatory medication: Diclofenac sodium 0.1% one drop four times daily beginning 24 hours after surgery and continuing through the first 2 weeks postoperatively 5

Communication and Support

• Assess barriers to communication including language or hearing impairment that may affect postoperative instruction comprehension 1
• Answer all patient questions about the surgery, recovery process, and expected timeline 1
• Verify the patient and any caregiver are committed to the postoperative care regimen 1

Expected Outcomes

• Visual improvement occurs in up to 90% of patients undergoing first-eye cataract surgery, with substantial positive impact on vision-dependent functioning 2
• Cataract surgery reduces fall risk by more than 30% and may reduce dementia risk by 20-30% 3
• The procedure can reduce dependence on eyeglasses, particularly with advanced technology IOL options 3