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Preoperative evaluation for cataract surgery

See, Craig W.a; Iftikhar, Mustafab; Woreta, Fasika A.b

Current Opinion in Ophthalmology: January 2019 - Volume 30 - Issue 1 - p 3–8
doi: 10.1097/ICU.0000000000000535

Purpose of review To provide a consolidated update regarding preoperative evaluation for cataract surgery.

Recent findings Visual acuity alone is a poor gauge of cataract disability. Modalities such as wave front aberrometry, lens densitometry, and light-scatter assessments can quantify optical aspects of cataract and may prove clinically useful in surgical evaluation. Advances in biometry are driving improvements in refractive outcomes, which in turn have increased patient expectations. Future advances in biometry technology may include three-dimensional imaging of the cornea and lens. Screening for ocular comorbidities has become increasingly important, particularly to guide lens selection. Risk stratification systems can help guide surgical decisions and may decrease intraoperative complication rate. A comprehensive medical history and physical is currently mandated for all Medicare patients undergoing cataract surgery but may be of limited utility for low-risk patients.

Summary Rising patient expectations and a growing number of surgical choices have expanded the cataract preoperative evaluation. A systematic and comprehensive examination which includes identifying any ocular comorbidity is essential for surgical planning and counseling on visual prognosis. New technologies will continue to inform, but not replace, sound clinical judgment.

aCole Eye Institute, Cleveland Clinic, Cleveland, Ohio

bWilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Correspondence to Craig W. See, MD, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA. Tel: +1 216 444 5898; e-mail:

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