Cataract Pre-Op

iStock_000022542067_sizedCataract surgery seems to be almost a rite of passage among elderly people in the United States, with the procedure itself complicated by the sometimes endless round of preoperative evaluations and procedures some ophthalmologists require, even though a Johns Hopkins study done over 10 years ago clearly establishes both the safety of the procedure and the lack of benefit seen with additional testing preoperatively.  Now, as Rick and I discuss on PodMed this week, a study in the New England Journal of Medicine reiterates these facts and adds more to the the body of evidence.

Researchers took a random sample of 500,000 Medicare beneficiaries who had cataract surgery in 2011 and identified preoperative tests they underwent.  The results reveal an astonishing 53% had at least one preoperative test, with both costs relative to the testing and subsequent physician follow-up in the millions of dollars.  Even more revealing was the identification of a cohort of ophthalmologists who were ordering the overwhelming majority of preoperative testing, causing me to quip to Rick that perhaps now that we know who's doing it, just like the opioid prescribing docs in Florida, we can target interventions to get them to stop. In any case, Rick feels strongly that persons who are planning cataract surgery should cite safety statistics of a less than 1% rate of complications and just say no to preoperative testing.

Other topics this week include a look at gestational diabetes and offspring autism risk, and mechanical versus tissue valves for mitral valve replacement, both in JAMA, and back to NEJM for a novel target for lowering cholesterol.  Until next week, y'all live well.

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