Cardiopulmonary Clearance Before Cataract Surgery

Risk Stratification

Cataract surgery is classified as very low-risk for major adverse cardiac events (MACE), equivalent to plastic surgery in perioperative risk, according to the American College of Cardiology 1
Patients in their usual state of health undergoing cataract surgery do not require preoperative cardiopulmonary testing or formal medical clearance, regardless of a history of COPD or stable heart disease, as recommended by the American Academy of Family Physicians and the American Academy of Ophthalmology 2, 3

COPD patients do not require special perioperative cardiac risk management, as COPD does not independently increase cardiac risk during low-risk surgery, according to the European Heart Journal 4
Stable heart failure patients without active decompensation do not require additional testing beyond their routine management, as recommended by the American Academy of Ophthalmology 3

Only patients with active or unstable cardiopulmonary disease require preoperative medical evaluation, according to the American Academy of Ophthalmology 3
Active cardiac conditions, such as unstable angina, recent myocardial infarction, decompensated heart failure, or significant arrhythmias, require preoperative medical evaluation, as recommended by the American Academy of Ophthalmology 3
Severe pulmonary disease, such as poorly controlled COPD with acute exacerbation or pulmonary arterial hypertension, requires preoperative medical evaluation, according to the European Heart Journal and the American Academy of Ophthalmology 3, 4

Three randomized clinical trials demonstrated that preoperative medical evaluation does not reduce systemic or ocular complications in cataract surgery patients, as reported by the American Academy of Ophthalmology 3

Beta-blockers should be continued if on chronic therapy, as recommended by the American Society of Anesthesiologists (Class I, Level B recommendation) 5
ACE inhibitors/ARBs should be continued in stable heart failure patients, as recommended by the American Society of Anesthesiologists (Class IIb, Level C) 5
Statins should be continued perioperatively, as recommended by the American Society of Anesthesiologists (Class I, Level B) 5

The American College of Cardiology recommends that patients with stable hypertension and coronary artery disease can undergo cataract surgery without additional cardiac testing, as long as they are asymptomatic and have no active cardiac conditions 6.
The European Heart Journal guidelines state that chronic obstructive pulmonary disease (COPD) does not independently increase cardiac risk, and special perioperative cardiac risk management for patients with COPD is not recommended 7.
The American College of Cardiology advises against using the phrase "cleared for surgery," and instead recommends documenting cardiovascular stability and any relevant medical conditions, such as COPD status and medication continuation 8.
Stage 1 or stage 2 hypertension is not an independent risk factor for perioperative cardiovascular complications, and patients with well-controlled hypertension can undergo cataract surgery without additional cardiac testing 9.

Patients with COPD should have their medications optimized to minimize perioperative respiratory issues, and should continue their medications through the perioperative period 7.
Patients with coronary artery disease should have their medications optimized, including beta-blockers, ACE inhibitors/ARBs, and statins as indicated, and should continue their medications through the perioperative period 8.
Topical or local anesthesia is recommended for cataract surgery to minimize systemic stress, and standard ASA monitoring is sufficient, with no enhanced cardiac monitoring required 6, 8.

Postoperative troponin measurement is not recommended in asymptomatic stable patients undergoing low-risk surgery, such as cataract surgery 8.