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Routine medical testing before cataract surgery usually is not necessary

Since 1984, nearly all cataract surgeries in the United States have been done on an outpatient basis, with low rates of complications and deaths. However, patients with cataracts tend to be elderly and to have serious coexisting illnesses. As a result, many doctors believe that a medical examination with laboratory testing must be performed before a patient can be considered eligible for surgery. However, a recent study found that routine medical testing before cataract surgery does not increase the safety of the surgery, and for the most part, is unnecessary.

The overall rate of intraoperative and postoperative complications was the same for patients who underwent a standard battery of laboratory tests and those who did not (31 medical events per 1,000 operations). Most problems occurred during surgery and were not serious, and it was rarely judged that medical tests would have helped to reduce the risk or severity of these problems. Also, there was no evidence that preoperative medical testing resulted in postponement or cancellation of surgery for patients found to be at risk for medical problems.

Of course, this does not mean that medical testing is unhelpful or not indicated for all patients. However, tests prior to cataract surgery should be ordered only when the history or a finding on physical examination indicates the need for a test, even if surgery had not been planned (for example, new or worsening angina would almost certainly prompt electrocardiography even if the patient was not scheduled for cataract surgery).

These findings are based on a study supported by the Agency for Healthcare Research and Quality (HS08331), which was led by Oliver D. Schein, M.D., M.P.H., of Johns Hopkins University. Dr. Schein and his colleagues randomly assigned elective cataract operations in 18,189 patients at nine centers to be preceded or not preceded by a standard battery of tests ranging from electrocardiography and complete blood count to measurement of serum glucose, electrolytes, urea nitrogen, and creatinine.

See "The value of routine preoperative medical testing before cataract surgery," by Dr. Schein, Joanne Katz, Sc.D., Eric B. Bass, M.D., M.P.H., and others, in the January 20, 2000, New England Journal of Medicine 342, pp. 168-175.

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