Let’s talk about something deeply unsexy but incredibly important: pre-op clearance for cataract surgery.

After watching a colleague get sent to their own primary care doctor for a seven-minute procedure under minimal sedation, I realized how far we’ve drifted from common sense. Cataract surgery is one of the safest, most routine operations in medicine, yet we’re still funneling millions of patients into unpaid, unnecessary pre-op visits.

In this episode, I break down how we got here, why ophthalmologists end up looking like the bad guys, and how liability culture, not patient safety, is driving a lot of these decisions. Then we pivot to something more personal and more complicated: chronic eye pain after LASIK, why it’s so hard to treat, and why psychiatry might need to be part of the care team more often than we’re comfortable admitting.

Takeaways:

Why requiring universal pre-op H&Ps for cataract surgery is more about shifting blame than reducing risk.

How liability fear has quietly reshaped outpatient surgery policies and strained relationships with primary care.

The uncomfortable truth: ophthalmologists are trained to assess surgical risk and shouldn’t outsource it by default.

Why chronic neuropathic eye pain after LASIK is rare, devastating, and incredibly hard to explain, especially when exams look normal.

How reframing psychiatry as a collaborator, not a last resort, might help patients whose pain lives at the intersection of eye and brain.

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