ICO International Clinical Guidelines:

Cataract (Initial and Follow-up Evaluation)

(Download this Guideline as a PDF file - 101 KB)

On this page:

• Initial exam history
  
  
• Initial physical exam
  
  
• Care management
  
  
• Preoperative care
  
  
• Follow-up evaluation
  
  
• Nd:YAG laser capsulotomy
  
  
• Patient Education

Initial Exam History

• Symptoms [A:II]
  
  
• Ocular history [A:III]
  
  
• Systemic history [A:III]
  
  
• Assessment of visual functional status [A:II]

Initial Physical Exam

• Visual acuity, with current correction [A:III]
  
  
• Measurement of BCVA (with refraction when indicated) [A:III]
  
  
• Ocular alignment and motility [A:III]
  
  
• Pupil reactivity and function [A:III]
  
  
• Measurement of IOP [A:III]
  
  
• External examination [A:III]
  
  
• Slit-lamp biomicroscopy [A:III]
  
  
• Evaluation of the fundus (through a dilated pupil) [A:III]
  
  
• B-Scan ultrasonography (when fundus in not visible)
  
  
• Assessment of relevant aspects of general and mental health [B:III]

Care Management

• Treatment is indicated when visual function no longer meets the patient's needs and cataract surgery provides a reasonable likelihood of improvement. [A:II]
  
  
• Cataract removal is also indicated when there is evidence of lens-induced disease or when it is necessary to visualize the fundus in an eye that has the potential for sight. [A:III]
  
  
• Surgery should not be performed under the following circumstances: [A:III] glasses or visual aids provide vision that meets the patient's needs’, surgery will not improve visual function; the patient cannot safely undergo surgery because of coexisting medical or ocular conditions; appropriate postoperative care cannot be obtained.
  
  
• Indications for second eye surgery are the same as for the first eye. [A:II] (with consideration given to needs for binocular function)

Preoperative Care

Ophthalmologist who is to perform the surgery has the following responsibilities:

• Examine the patient preoperatively [A:III]
  
  
• Ensure that the evaluation accurately documents symptoms, findings and indications for treatment [A:III]
  
  
• Inform the patient about the risks, benefits and expected outcomes of surgery [A:III]
  
  
• Formulate surgical plan, including selection of an IOL [A:III]
  
  
• Review results of presurgical and diagnostic evaluations with the patient [A:III]
  
  
• Formulate postoperative plans and inform patient of arrangements [A:III]

Follow-up Evaluation

• High-risk patients should be seen within 24 hours of surgery. [A:III]
  
  
• Routine patients should be seen within 48 hours of surgery. [A:III]
  
  
• Components of each postoperative exam should include:
  
  
  • Interval history, including new symptoms and use of postoperative medications. [A:III]
    
    
  • Patient's assessment of visual functional status. [A:III]
    
    
  • Assessment of visual function (visual acuity, pinhole testing). [A:III]
    
    
  • Measurement of IOP. [A:III]
    
    
  • Slit-lamp biomicroscopy. [A:III]

Nd:YAG Laser Capsulotomy

• Treatment is indicated when vision impaired by posterior capsular opacification does not meet the patient's functional needs or when it critically interferes with visualization of the fundus. [A:III]
  
  
• Educate about the symptoms of posterior vitreous detachment, retinal tears and detachment and need for immediate examination if these symptoms are noticed. [A:III]

Patient Education

• For patients who are functionally monocular, discuss special benefits and risks of surgery, including the risk of blindness. [A:III]

* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2006 (www.aao.org)

(Download this Guideline as a PDF file - 101 KB)

Next: Conjunctivitis (Initial evaluation)

Also see:

• International Clinical Guidelines (Preface)
  
  
• Introduction to the Guidelines
  
  
• List of Guidelines