OP8.3 | Cataract Surgery Preoperative Evaluation and Counselling — Summary & Reflection

KEY TAKEAWAYS

Preoperative evaluation for cataract surgery is a two-component process: safety assessment and informed consent counselling. The safety assessment uses Snellen VA, slit-lamp biomicroscopy, specular microscopy (corneal endothelial density — phaco risks below ~1000–1500 cells/mm²), tonometry (IOP control), biometry (axial length + keratometry for IOL power via SRK/T or Barrett formulae), and B-scan if fundus is obscured. Systemic evaluation focuses on DM (glucose control, concurrent macular oedema), hypertension (control <180/110 mmHg), anticoagulation management, and IFIS risk (tamsulosin). Surgical deferral is appropriate for uncontrolled systemic disease, active uveitis, or poor endothelial cell count requiring technique change. Patient counselling covers six elements: diagnosis, surgical technique, anaesthesia (most commonly topical or peribulbar — patient is awake but pain-free), risks (including PCO — 'not a return of cataract; treated by laser outpatient'), IOL options, and realistic visual expectations. Informed consent requires capacity, information, understanding, and voluntariness — with special attention to the one-eyed patient, illiterate patients, and those with concurrent posterior segment pathology limiting expected visual gain.

REFLECT

Return to Mrs. Padmavathi's questions from the opening scenario. She asked three things: (1) Will the cataract come back? (2) Will she be awake during surgery? (3) Will she go blind? Using what you have learned, draft a 3-minute verbal explanation that addresses all three, in language appropriate for a 65-year-old retired schoolteacher. Pay attention to: the specific language you use for PCO (what analogy would make it clear?), how you explain 'awake but comfortable' anaesthesia without triggering more anxiety, and how you contextualise the risk of blindness honestly (what is the approximate incidence of endophthalmitis?) without either minimising it or catastrophising it. This is the core of the consultation skill you will be examined on — not a script, but a structured, empathic, accurate conversation.