Preoperative Evaluation of Patients Undergoing Cataract Surgery: Recommendations, Challenges, and Ethical Considerations

Cataract surgeries are among the most common outpatient procedures in the United States, typically accomplished with topical anesthesia and light sedation. Evidence demonstrates no benefit for comprehensive preoperative medical evaluation before low-risk procedures. In 2019, the Centers for Medicare & Medicaid Services (Baltimore, Maryland) revised regulations for hospitals and ambulatory surgery centers, eliminating the previous requirement for a history and physical examination within 30 days of ambulatory surgeries, regardless of risk. Professional guidance from the Society for Ambulatory Anesthesia (Milwaukee, Wisconsin) and the American Academy of Ophthalmology (San Francisco, California) confirms that routine, comprehensive evaluation before cataract surgeries is nonbeneficial. Despite alignment of evidence, regulatory guidance, and expert consensus, implementation has been inconsistent. Unnecessary evaluations delay care and create barriers for patients with vision impairment. This article describes efforts to streamline preoperative evaluation for low-risk eye surgeries and underscores the ethical imperative of reducing low-value practices in perioperative medicine, particularly for vulnerable patient populations.