Elevated A1C...Do You Schedule or Hold Off?
Many of our cataract patients have diabetes (DM), with our standard-of-care to delay surgery until blood glucose levels are well controlled. The thinking being individuals with uncontrolled DM have less predictable or effective immune function which only increases risk of post-op infection and/or healing times. Therefore, defining a safe glycemic threshold for cataract surgery has always been a key factor before moving forward and scheduling.
Surprisingly, it is now being shown the relationship between preoperative hemoglobin A1c (HbA1c) levels and postoperative outcomes, including risk of post-operative endophthalmitis and serious medical events, may not be as critical as what we have thought. Findings after reviewing large-scale databases suggest surgery may be performed safely even in patients with HbA1c levels exceeding 11.3%!...challenging traditional beliefs about strict glycemic control.
This matters in terms of importance to individualize our pre-op assessments and management, perhaps permitting us to proceed sooner with scheduling surgery - especially with patients who are increasingly struggling with their daily activities. However, despite this new take on the A1C dynamic, our protocols are not likely to change soon. And be reminded, statistics are just statistics and we know DM is often present with additional risk factors - assume nothing and always proceed with caution.
Go to the article in the American Journal of Ophthalmology HERE.
-JRM
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