Cataract Surgery Does Not Require the Pre-Op Tests Doctors Like to Perform

Surgery to remove cataracts is a common procedure accompanied by, apparently, an equally common preoperative routine of testing that appears to be wholly unnecessary.

According to a study in the New England Journal of Medicine, (NEJM) “preoperative testing is not recommended for patients undergoing cataract surgery, because testing neither decreases adverse events nor improves outcomes.”

You can’t get much clearer than that: Testing doesn’t lower the rate of complication, and it doesn’t elevate the rate of success. So why do eye surgeons seem to love it so much?

The study indicates that it’s, well, a habit. Providers do it because they’ve always done it. It’s not about the patient, it’s about the specialty and its perpetual motion machine-like mind-set.

As the NEJM said, “Preoperative testing before cataract surgery occurred frequently and was more strongly associated with provider practice patterns than with patient characteristics.”

Cataracts make the normally clear, transparent lens of the eye vision cloudy or opaque. Not only do they compromise vision, they can, eventually, lead to blindness.

Cataract surgery removes the natural lens of the eye and replaces it with an artificial lens. Typically, it’s done on an outpatient basis.

According to, preoperative testing can include blood work, urinalysis, cardiac stress tests, etc., that haven’t been recommended “for more than a dozen years.

“There’s good reason for that: The eye surgery generally takes less time than watching a rerun of ‘Marcus Welby, MD’ – just 18 minutes, on average. It’s also incredibly safe, with a less than 1 percent risk of major cardiac problems or death.”

The researchers looked at the data of Medicare beneficiaries undergoing cataract surgery in 2011. They determined the prevalence and cost of preoperative testing in the month before surgery, and compared it with the prevalence of preoperative testing and office visits with beneficiaries who underwent tests and had office visits during the preceding 11 months. They looked at the relationship between preoperative testing and characteristics of patients, health system characteristics, surgical setting, care team and occurrence of a preoperative office visit.

Of 440,857 patients, slightly more than half had at least one preoperative test in the month before surgery. Those tests cost $4.8 million more and the cost of office visits was $12.4 million more than the monthly costs during the preceding 11 months.

More than 1 in 3 ophthalmologists ordered preoperative tests for more than 3 in 4 of their patients. “A patient’s probability of undergoing testing,” said the NEJM, “was associated mainly with the ophthalmologist who managed the preoperative evaluation.”

Cataract surgery, according to KHN, used to take hours and require general anesthesia, which would make preoperative testing more reasonable. Today, patients often receive only a topical anesthetic eye drop or sometimes a local anesthetic that may include a sedative for relaxation.

“It’s so low risk,” Dr. Catherine Chen, an anesthesiologist, told KHN, ” it’s almost like saying you’re going to get your nails done. There’s always a chance you’ll get hit by a car or have a heart attack on the way,” but not likely to happen at the nail salon.

For all its ardor for new technology, medicine can still be like the ocean ship so large that it can’t respond in time when a course change is required to avoid danger. It seems certain medical procedures are the same, and it’s inexcusable to waste money and run the risk of complications by performing tests that have been demonstrated clearly not to help.

If you are scheduled for cataract surgery, and your ophthalmologist wants you to have pre-op tests, find out why. According to this study, it’s could be for no reason whatsoever.

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