Presurgical evaluation of patients with cataracts

To evaluate a patient properly for cataract surgery, a thorough history must be taken, visual acuity must be measured, and eye health must be assessed. Specialized testing may include ophthalmic ultrasonography, glare or contrast-sensitivity testing, and estimation of postoperative acuity, which requires use of a potential acuity meter or an interferometer. For patients with dense or mature cataracts, macular integrity must be carefully evaluated with techniques such as ophthalmoscopy or posterior pole biomicroscopy, color perception, two-light discrimination ability, Maddox rod test, perception of entoptic phenomena, and electrophysiological testing. Specular microscopy must also be performed to evaluate the corneal endothelium. Criteria for referral should be adopted by all optometrists to aid patients in determining when surgery is advisable.