In a health care system with finite resources, we need appropriateness guidelines to facilitate access and planning and to prevent abuse. Cataract surgery is one of the most commonly performed procedures worldwide, with overall high patient satisfaction and societal impact. In contrast to other elective procedures, such as knee arthroscopy, where evidence is limited, there is clear visual and functional benefit for patients suffering from cataract symptoms. 1 While in principle it makes sense to have rules in place to guide appropriateness, misguided or overly simplistic rules actually could cause harm. Herein, we present some considerations in developing appropriateness guidelines.