• AAO PPP Cataract and Anterior Segment Panel, Hoskins Center for Quality Eye Care
    Cataract/Anterior Segment
    By the American Academy of Ophthalmology Preferred Practice Pattern Cataract and Anterior Segment Committee: Kevin M. Miller, MD,1 Thomas A. Oetting, MD,2 James P. Tweeten, MD,3 Kristin Carter, MD,4 Bryan S. Lee, MD, JD,5 Shawn Lin, MD, MBA,6 Afshan A. Nanji, MD,7 Neal H. Shorstein, MD,8 David C. Musch, PhD, MPH9

    As of November 2015, the PPPs are published online-only in the Ophthalmology Journal and may be freely downloaded in their entirety by all visitors. Open the PDF for this entire PPP or click here to access the PPP on the journal's site. Click here to access the journal's PPP collection page.

    1Kolokotrones Chair in Ophthalmology, Chief of the Cataract and Refract Surgery Division, David Geffen School of Medicine at UCLA and Stein Eye Institute, Los Angeles, CA
    2Margaret and Rudy Perez Professor of Ophthalmology Education, University of Iowa, Iowa City, IA
    3Intermountain Eye Center, Boise, ID
    4Clarity Eye Care & Surgery, Tucson, AZ
    5Altos Eyes Physicians, Los Altos, CA
    6Medical Director, UCLA Calabasas Stein Eye Center, Associate Program Director, UCLA Ophthalmology Residency, Division of Cataract & Refractive Surgery, Los Angeles, CA
    7Assistant Professor of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR
    8Ophthalmologist & Researcher, Chief of Quality, Kaiser Permanente, Walnut Creek, CA
    9Professor, Department of Ophthalmology and Visual Sciences, Medical School, Professor, Depart of Epidemiology, School of Public Health, Kellogg Eye Center, University of Michigan, Ann Arbor, MI

    Highlighted Findings and Recommendations for Care


    Symptomatic cataract is a surgical disorder. Dietary intake and nutritional supplements have demonstrated minimal effect on the prevention or treatment of cataract.

    Most cataract surgery in the United States is performed by small-incision phacoemulsification with foldable intraocular lens (IOL) implantation on an outpatient basis.

    Refractive cataract surgery, including astigmatism management, intraoperative refractive guidance, and specialty IOL implantation, has the potential to reduce a patient's dependence on eyeglasses or contact lenses for distance, intermediate, and near vision.

    Femtosecond laser-assisted cataract surgery (FLACS) increases the circularity and centration of the capsulorrhexis and the precision of the corneal incisions. It may also reduce the amount of ultrasonic energy required to remove a cataract. However, the technology is not yet cost-effective, and the overall risk profile and refractive outcomes have not been shown to be superior to that of standard phacoemulsification.

    Topical nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the incidence of early postoperative cystoid macular edema (CME), but a long-term benefit has not been demonstrated.

    There is substantial evidence that intracameral antibiotic administration reduces the risk of postoperative bacterial endophthalmitis. Increasing evidence also suggests that topically applied antibiotics do not add to the benefit of intracameral injection.

    Minimally invasive glaucoma surgery can enhance the intraocular pressure-lowering effects of cataract surgery in some patients with mild to moderate glaucoma.