Variation in Cataract Surgery Practice and Clinical Outcomes
Authors: Oliver D. Schein, Earl P. Steinberg, Jonathan C. Javitt, Sandra D. Cassard, James M. Tielsch, Donald M. Steinwachs, Marcia W. Legro, Marie Diener-West, Alfred Sommer
Journal: Ophthalmology (1994)

Purpose: To examine associations between surgical technique, patient and surgeon characteristics, and clinical outcomes of cataract surgery. Methods: Seventy-five ophthalmologists were recruited from three cities based on a sampling scheme stratified by surgeon-reported annual volume of cataract surgery. Seven hundred seventy-two patients undergoing first eye cataract surgery were enrolled, with complete preoperative, perioperative, and 4-month postoperative clinical data on 717 patients (93%). Results: Sixty-five percent of surgery was performed by phacoemulsification and 35% by standard extracapsular (ECCE) techniques. Performance of ECCE was associated with the presence of ocular comorbidity and 21 or more years in practice of the surgeon. Performance of phacoemulsification was associated with annual volume of cataract surgery, wherein high-volume (201–399 patients annually) and very high-volume (>400 patients annually) surgeons had 3.7 and 3.9 times the likelihood of performing phacoemulsification compared with moderate-volume (51–200 cases annually) surgeons. The rates of intraoperative, perioperative, and 4-month postoperative adverse events and the amount of improvement in visual acuity did not differ either by surgical technique or volume stratum. The reported occurrence of posterior capsular opacification within 4 months of surgery was increased in the presence of cortical opacification, one city, and patients operated on by either high- or very high-volume surgeons. Conclusions: In this cohort, no difference in clinical outcomes, as measured by change in visual acuity or occurrence of postoperative adverse events (except for posterior capsular opacification), can be attributed to performance of phacoemulsification versus ECCE or to the reported annual volume of cataract surgery of the surgeon. Selfreported high and very high annual volume of cataract surgery is associated independently with performance of phacoemulsification and surgeon's report of posterior capsular opacification at 4 months after cataract surgery. Purpose: To examine associations between surgical technique, patient and surgeon characteristics, and clinical outcomes of cataract surgery. Methods: Seventy-five ophthalmologists were recruited from three cities based on a sampling scheme stratified by surgeon-reported annual volume of cataract surgery. Seven hundred seventy-two patients undergoing first eye cataract surgery were enrolled, with complete preoperative, perioperative, and 4-month postoperative clinical data on 717 patients (93%). Results: Sixty-five percent of surgery was performed by phacoemulsification and 35% by standard extracapsular (ECCE) techniques. Performance of ECCE was associated with the presence of ocular comorbidity and 21 or more years in practice of the surgeon. Performance of phacoemulsification was associated with annual volume of cataract surgery, wherein high-volume (201–399 patients annually) and very high-volume (>400 patients annually) surgeons had 3.7 and 3.9 times the likelihood of performing phacoemulsification compared with moderate-volume (51–200 cases annually) surgeons. The rates of intraoperative, perioperative, and 4-month postoperative adverse events and the amount of improvement in visual acuity did not differ either by surgical technique or volume stratum. The reported occurrence of posterior capsular opacification within 4 months of surgery was increased in the presence of cortical opacification, one city, and patients operated on by either high- or very high-volume surgeons. Conclusions: In this cohort, no difference in clinical outcomes, as measured by change in visual acuity or occurrence of postoperative adverse events (except for posterior capsular opacification), can be attributed to performance of phacoemulsification versus ECCE or to the reported annual volume of cataract surgery of the surgeon. Selfreported high and very high annual volume of cataract surgery is associated independently with performance of phacoemulsification and surgeon's report of posterior capsular opacification at 4 months after cataract surgery.