Cataract surgery is practiced widely and substantial resources are being committed to increasing the cataract surgical rate in developing countries. With the current volume of cataract surgery and the increases in the future, it is critical to be able to optimize the safety, but also the cost effectiveness of this procedure. Most cataracts are age-related and therefore surgeries are performed on older individuals with correspondingly high systemic and ocular comorbidities. It is likely that preoperative medical testing will detect medical conditions but it is questionable whether these conditions should preclude these individuals from cataract surgery or change their perioperative management.
Three randomized clinical trials were identified from the literature which examined the impact of preoperative medical testing on the risk of medical adverse events. Preoperative medical testing did not reduce the risk of intraoperative or postoperative medical adverse events when compared to selective or no testing. Cost was evaluated in one study which estimated the cost to be 2.55 times higher in those who had routine preoperative medical testing compared to those who had selective preoperative testing. There was no difference in the cancellation of surgery between those with routine preoperative medical testing and those with no or limited preoperative testing.