Pre-operative evaluation:
HPI functional visual decline
PMH DM, asthma, COPD, CHF, problems with bleeding, allergies
Meds Coumadin, ASA (is their blood esp thick or do they have a medical problem)
SH Occupation that requires special visual powers
Can they tolerate the post operative care, eg put in drops, monocular
POH h/o glaucoma, steroid response, h/o RD, h/o macular edema, h/o sugery other eye
Read current glasses -- especially important to know spherical equivalent of fellow eye
Eye exam:
VA     Streak or MR for best corrected visual acuity in dim and bright light
When vision is poor - doc no improvement with up to an addition of -3.00
RAPD -- very important when the vision remains poor after cataract extraction
Undilated pupil size -- useful when selecting among IOL optic diameters, esp young pts
Dilated pupil Size - useful when selecting among surgeons
    If the pupil dosen't dilate - have a plan, eg. Retractors, stretch, sphincterotomy
CVF    LP in all four quadrants in dense cataracts
Keratometer readings of both eyes -- do prior to other K manipulations
External     abnormal tear fcn, malposition, blepharitis/spasm
Prom brow/deep socket think temporal or schedule next resident
SLE     Mainly look at the cornea -- any edema or guttata, beware if thicker than 620 µm lens hardness, phacodynesis, PXF
Gonioscopic exam of hyperopes, diabetics, and patients with h/o trauma
Dilated examination     not mandatory if you have looked back recently (w/in month)
does the poor view match the poor vision
look carefully at pts with DM, consider preop focal, FFA
document normal macula, ON, PVD if present
Special Tests: laser interferometry - diffraction pattern on retina to estimate VA potential
potential acuity meter - projects a teeny Snellen chart around lens opacity
neither test is that helpful in my opinion
Consider echography when you have no view
Axial Eye length (AEL) measurement
Specular microscopy of the endo cell to determine cells/mm2 in special cases eg. Fuchs
Body Exam History and physical is brief: can they lie flat and still; if not why not?


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