IS A PRE-MEDICAL CLEARANCE REQUIRED BEFORE A CATARACT SURGERY?

The American Academy of Ophthalmology recommends against routine medical tests before cataract
surgery, although pre-operative medical tests can be ordered when indicated by findings on a patient's
history or physical examination.1 http://www.aafp.org/afp/2009/1201/p1228.html

Study entitled Are routine preoperative medical tests needed with cataract surgery?
http://www.scielosp.org/pdf/rpsp/v10n1/5846.pdf

For patients undergoing cataract surgery there is a marked variation within and across physician specialties
concerning the use of and rationale for medical tests, according to a survey conducted with ophthalmologists,
anesthesiologists, and internists in the United States of America.

The use of selective laboratory testing based on the medical history and the judgment of the surgeon in
collaboration with capable consultants has been shown to be effective in recognizing subclinical problems in
high-risk individuals and managing potentially complicating conditions

We believe medical assessment provides an important opportunity for physicians to reduce perioperative
morbidity by optimizing preoperative status and planning perioperative management

The results of this study suggest that routine medical testing before cataract surgery does not reduce the rate of
complications during the perioperative period. The results also suggest it would be more efficient not to request
routine preoperative tests unless indicated by patient history or physical examination.

See Attached New York Presbyterian Columbia University Medical Center, Columbia Doctors Ophtahlmology
provides for a Pre-Surgical Medical Clearance, that says;

You must obtain medical clearance from the physicial who manages your medical care, within 30 days of your
scheduled surgery date.

If you are 60 years of age or older, you are required to have an ECG.

[This is in consideration of the advanced age of the patient and the probable risk that comes with age. In like
manner, a requirement of a Pre-Medical Clearance would apply the same logic.] http://www.columbiaeye.org

Editorial by MITCHELL S. KING, M.D, Northwestern University Medical School, Chicago, Illinois

A history and physical examination, focusing on risk factors for cardiac, pulmonary and infectious
complications, and a determination of a patient's functional capacity, are essential to any preoperative
evaluation.

The purpose of a preoperative evaluation is not to clear patients for elective surgery, but rather to
evaluate and, if necessary, implement measures to prepare higher risk patients for surgery. Pre-
operative outpatient medical evaluation can decrease the length of hospital stay as well as minimize
postponed or cancelled surgeries.1 To effectively provide this consultative service, the physician should
understand the risk associated with the particular type of surgery planned and relate this risk to the patient's
underlying acute and chronic medical problems. The complete consultation should include
recommendations for evaluation and treatment, including prophylactic therapies to minimize the
perioperative risk. http://www.aafp.org/afp/2000/0715/p387.html

WHEN IS PRE-MEDICAL CLEARANCE REQUIRED.

Before beginning a new exercise program or undergoing a medical procedure such as surgery, an individual
may be advised to obtain medical clearance from his or her doctor. Sometimes, surgeons require a
patient to obtain clearance from his or her doctor or specialist before agreeing to perform surgery.
This is especially true before very intensive or invasive surgeries and for patients with known health
conditions.

Preoperative testing is often performed before surgical procedures. These investigations can be
helpful to stratify risk, direct anesthetic choices, and guide postoperative management, but often are
obtained because of protocol rather than medical necessity. The decision to order preoperative tests should
be guided by the patient's clinical history, comorbidities, and physical examination findings.

The goal of preoperative evaluation is to identify and optimize conditions that increase perioperative
morbidity and mortality. More recent practice guidelines continue to recommend testing in select patients
guided by a perioperative risk assessment based on pertinent clinical history and examination findings,
although this recommendation is based primarily on expert opinion or low-level evidence.