Authors: John P et al.
Anesthesiology 144(4):771–775, April 2026
Summary:
This article addresses the persistent overuse of comprehensive preoperative evaluations for cataract surgery, despite strong evidence and regulatory changes showing they provide no clinical benefit. Cataract surgery is a low-risk outpatient procedure typically performed with topical anesthesia and minimal sedation, yet many patients continue to undergo unnecessary testing and in-person evaluations.
The authors highlight that the Centers for Medicare & Medicaid Services removed the requirement for routine preoperative history and physical examinations for low-risk procedures in 2019, encouraging a more individualized, risk-based approach. This shift is supported by professional societies, yet clinical practice has been slow to change, with unnecessary evaluations still creating delays, increasing costs, and limiting access to care.
A key focus of the article is the concept of low-value care and its disproportionate impact on vulnerable populations—particularly patients with visual impairment. Requiring unnecessary in-person evaluations can act as a barrier to care, effectively delaying surgery and worsening quality of life. The authors frame this not just as an inefficiency, but as an ethical issue involving violations of beneficence, nonmaleficence, and justice.
The article presents a practical, system-based solution using streamlined preoperative pathways, including virtual assessments and structured screening tools. These approaches allow clinicians to identify patients who truly need further evaluation while eliminating unnecessary visits for low-risk individuals. Implementation of such systems has been shown to reduce cancellations, improve efficiency, and enhance patient access.
Ultimately, the article calls for anesthesiologists and perioperative leaders to embrace evidence-based, value-driven care by eliminating unnecessary preoperative testing and aligning practice with current guidelines and ethical principles.
Key Points:
- Routine preoperative testing for cataract surgery provides no clinical benefit
- CMS and professional societies recommend risk-based, simplified evaluation
- Unnecessary evaluations delay care and increase costs
- Vulnerable patients, especially those with visual impairment, are disproportionately affected
- System-based approaches (e.g., virtual screening) can improve efficiency and access
What You Should Know:
This is low-value care that we continue to tolerate. These patients don’t need testing—they need surgery. Every unnecessary requirement we add delays care and creates barriers, especially for vulnerable patients. This is both a systems problem and an ethical one.
We would like to thank Anesthesiology for allowing us to summarize and share this article.