A recent study found an association between increased annual surgeon cases and a statistically significant but clinically modest improvement in uncorrected visual acuity (UCVA) in phacoemulsification cataract extraction—but not in small-incision cataract surgery. Nevertheless, increased annual case volume was associated with significantly lower complication rates, both in phaco and small-incision surgeries.
Researchers analyzed 35,880 eyes and 91,084 surgeries performed by 69 surgeons with varied annual case volume from 76 to 2,900 cases. The association between case volume and improvement in UCVA was most pronounced when researchers compared surgeons with case volumes of 350 phacoemulsification cataract extractions a year or fewer. The study also associated younger patient age with improved visual acuity outcomes and lower complication rates in both surgeries. Greater surgeon experience was associated with lower complication rates in phaco but not small-incision cataract surgery, and the study found no significant association with visual acuity outcomes.
The study’s findings highlight the potential benefit of high-output clinics, where surgeons can perform a high number of cataract extractions annually. These clinics would be especially helpful to developing nations, where there is a large backlog of untreated cataracts, and the cataract-to-surgeon ratio is high.
|Cox JT, Subburaman G, Munoz B, et al. Visual acuity outcomes after cataract surgery: high- vs. low-volume surgeons. Ophthalmology. April 9, 2019. [Epub ahead of print].