[Examination strategies in the preparative phase for cataract operations and artificial lens implantation]

The extraordinary increase in the number of posterior chamber intraocular lenses (IOLs) implanted in recent years has completely changed our attitude towards cataract patients. A few years ago, the goal of preoperative evaluation was to select ideal candidates for implantation. In the meantime, contraindications to IOLs have become very rare and many tests have been developed to objectify and quantify lens opacities in patients with good visual acuity (glare disability tests, contrast sensitivity tests), or to predict the functional clinical result (macular function tests). The value of these tests is reduced by the rate of false-positive or false-negative results. A meticulously recorded history and careful enlightenment of the patient are indispensable to avoid postoperative disappointment. Slit-lamp observation and biometry are the only mandatory tests for establishing the presence of a cataract and planning the surgical approach. All modern tests attempt to substitute automatic or semi-automatic measurements for clinical judgment, but indication for cataract surgery nevertheless remains a clinical act.