Cataract preoperative workup: before cataract surgery
The cataract preoperative workup — biometry, OCT, corneal topography — and intraocular lens selection: everything you need to know before your cataract surgery.
When and why is the cataract preoperative workup needed?
A pre-operative consultation takes place 4 to 6 weeks before any cataract surgery. This cataract preoperative workup is essential: its purpose is to assess the cataract, check for any other condition that could hinder visual recovery, choose the most suitable intraocular lens, and provide you with all the necessary information; it is systematic before every cataract operation.
It takes place at the practice in a single visit lasting approximately 1 hour. All the tests are quick and painless. At the end of the consultation, you leave with a surgery date, a detailed cost estimate and all the necessary prescriptions.
The cataract preoperative workup is systematic before any cataract surgery and is a key step in your care pathway.
The clinical examination of the cataract preoperative workup
A thorough clinical examination of each segment of the eye is performed as part of the cataract preoperative workup, in order to assess the cataract and identify any other ocular abnormalities.
Slit lamp
Examination of the anterior segment of the eye to assess the cataract and its impact on vision. It also looks for other abnormalities, such as cornea guttata, which indicates corneal fragility and requires additional precautions during surgery.
Dilated fundus examination
Complete examination of the retina after pupil dilation with eye drops. It allows assessment of the optic nerve, the central and peripheral retina, looking for other abnormalities (macular epiretinal membrane, macular hole, retinal tear).
These clinical tests are an integral part of the cataract preoperative workup and are performed during the same consultation.
The imaging tests of the cataract preoperative workup
The cataract preoperative workup combines a set of state-of-the-art imaging tests and a comprehensive medical evaluation. Each test provides essential information for planning your surgery and selecting your intraocular lens.
Ocular biometry
Precise measurement of the dimensions of your eye: axial length, corneal curvature, anterior chamber depth. These measurements are used to calculate the exact power of your future intraocular lens.
Corneal topography
Mapping of the surface of your cornea — comparable to a map measuring the shape of the front of your eye. The goal is to measure any astigmatism and, if necessary, select an intraocular lens that will correct it at the same time as the cataract.
Macular OCT
High-definition cross-sectional image of the back of the eye, to verify that the retina is healthy. AMD, an epiretinal membrane or a macular hole detected at this stage may limit visual recovery — it is essential to screen for them beforehand.
These imaging tests form the technical core of the cataract preoperative workup and make it possible to calculate the power of your intraocular lens with precision.
Learn more—docteurgozlan.fr Ocular biometry: how your intraocular lens is calculatedChoosing your intraocular lens during the cataract preoperative workup
During surgery, your clouded natural lens will be replaced by a transparent artificial intraocular lens (IOL), custom-calculated for you. This choice is permanent: the IOL remains in place for life, which is why it is discussed in detail with you during the cataract preoperative workup.
The choice of your intraocular lens depends on your lifestyle: are you used to wearing glasses? Do you drive, especially at night? Do you read for long periods? Do you work on a screen? Do you engage in precision activities? Dr Gozlan presents all the options and guides you through your decision during the cataract preoperative workup.
Fees and reimbursement of the cataract preoperative workup
Cataract surgery is partially covered by the French national health insurance (Sécurité sociale) and your supplementary insurance. The final fee depends on the type of intraocular lens chosen; a detailed cost estimate is provided during the cataract preoperative workup. A patient co-pay may apply.
Discussion with your surgeon
To help you prepare for this discussion, here is a list of useful questions to ask Dr Gozlan during your cataract preoperative workup.
What type of intraocular lens do you recommend for me, and why this one in my case?
What will my vision be like after surgery — for distance, near, or both?
Will I still need glasses after surgery, and for which activities?
Did you detect any other eye problems during the cataract preoperative workup?
What will the total out-of-pocket cost be for me?
What are the possible complications in my particular case?
When will my second eye be operated on, if both are affected?
What happens if I change my mind about the type of intraocular lens?
The anaesthesia consultation within the cataract preoperative workup
Meeting with the anaesthetist, mandatory before any surgical procedure, even for surgery under local anaesthesia such as cataract surgery. This step of the cataract preoperative workup allows the physician to review your medical history, current treatments and allergies in order to tailor the anaesthesia to your case.
This anaesthesia consultation is an integral part of the cataract preoperative workup.
Medications and anticoagulants: what to report during the cataract preoperative workup
Several treatments require special attention before cataract surgery. Below are the main recommendations — report them during your cataract preoperative workup and confirm them with your general practitioner and your anaesthetist.
Your anticoagulants and aspirin: to be continued
If you are taking anticoagulants or aspirin, these treatments are maintained for cataract surgery. Since the procedure is performed through a 2 mm micro-incision on a nearly closed eye, the risk of bleeding is negligible. Do not stop any medication without explicit instructions from your surgeon or anaesthetist.
Prostate medications: must be reported
If you are currently taking or have previously taken medication for benign prostatic hyperplasia, you must report this to your surgeon. These treatments alter iris behaviour during surgery and require an adapted surgical technique. This effect is permanent and persists even after the medication has been discontinued.
Other treatments to report
Long-term corticosteroid therapy, glaucoma treatment, known drug allergies, iodine intolerance. Bring your up-to-date medication list to your cataract preoperative workup.
The week after the cataract preoperative workup, before surgery
Your cataract preoperative workup is now complete. Here are the main steps to plan for in the week leading up to your surgery.
D-7 — Transport
Arrange transportation for the day of surgery: you will not be able to drive after the procedure. If you cannot be accompanied, ask your doctor for a medical transport prescription.
D-3 — Pharmacy
Pick up from the pharmacy the medications prescribed during your cataract preoperative workup, needed before and after surgery.
D-1 — Shower and preparation
Shower and shampoo with Betadine, short nails with no nail polish the evening before the procedure. Bring all the prescriptions issued during the cataract preoperative workup.
Day of surgery
Another shower and shampoo with Betadine. No cream or make-up. Be fasting (a light breakfast is allowed up to 6 hours before surgery). Instil the eye drops 1 hour before the procedure as per the prescription provided by the doctor.
Frequently asked questions about the cataract preoperative workup
The cataract preoperative assessment lasts between 45 minutes and 1 hour depending on the examinations required.
No, the cataract preoperative assessment does not require fasting: it consists solely of imaging tests, and you may eat normally.
Yes, at the end of the consultation to examine the back of your eye. Your vision will be blurred for 3 to 4 hours afterwards.
Not if your pupils have been dilated during the cataract preoperative assessment. Please arrange for someone to accompany you or use public transport/taxi.
It is a specialist preoperative assessment partially covered by the French national health insurance and your complementary cover. The fee is communicated when booking your appointment.
No. After your cataract preoperative assessment, a delay of 4 to 6 weeks is standard to plan the procedure properly.
Yes, up to approximately 1 week before the procedure; this deadline is confirmed during your preoperative assessment. Beyond that point, the implant has been custom-ordered and can no longer be changed.
No, no medication changes are required for the cataract preoperative assessment. Simply bring your current prescription.
Driving requires a minimum binocular visual acuity of 5/10 by law. If the cataract reduces vision below this threshold, driving becomes prohibited. Only an ophthalmological preoperative assessment can evaluate this.
Yes. Rigid lens wearers must remove them at least two weeks before biometry; soft lens wearers need three days. Wearing lenses during biometry can distort the implant power calculation.
References & medical sources
- Haute Autorité de Santé (HAS). Chirurgie de la cataracte chez l’adulte — bilan pré-opératoire et indications. Paris : HAS ; 2023.
- Norrby S. Sources of error in intraocular lens power calculation. J Cataract Refract Surg. 2008;34(3):368–376.
- Wang L, Koch DD. Intraocular lens power calculations in eyes with previous corneal refractive surgery. Eye Contact Lens. 2012;38(5):323–326.
- Gale RP, et al. Benchmark standards for refractive outcomes after NHS cataract surgery. Eye (Lond). 2009;23(1):149–152.
- Société Française d’Ophtalmologie (SFO). Rapport sur la chirurgie de la cataracte. Paris : Elsevier-Masson ; 2024.
- Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg. 2005;31(4):664–673.