I just presented at our local ophthalmology meeting about the lack of evidence supporting preoperative testing and clearance for cataract and other minimally invasive ocular surgeries. There is extensive evidence in the anesthesia literature to dissuade this practice, however it is still very prevalent. I think it's due to:
1. Habit - "this is the way it's been done for a long time and I'm not going to change"
2. Referals - keeps goodwill amongst your internists colleagues to send them patients for an easy pre op clearance visit.
3. Liability - a clearance note in the chart "releases" you of any responsibility in the case of a systemic complication in the perioperative period. Of course, this is not necessarily the case.
4. Surgery center rules - a few surgery centers require clearance and preop testing for all cases
I'm sure there are other reasons.
I personally write my own H and P the day of surgery for most of my patients. I ask for clearance only in those patients with poorly controlled systemic issues, those with heart or renal disease, and in select cases.
My view might be skewed a bit since I'm a retina specialist and quite a few of the surgeries I do are emergency procedures. Thus, I don't have the luxury of time to get patients cleared prior to surgery. Cataract doctors might have a different perspective.
