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  • Cataract Surgery, Surgeon Volume, and VA Results

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, November 2019

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    The association between higher cataract surgery volume and lower complica­tion rates is well recognized. However, data are limited on the relationship between case volume and visual outcomes. Cox et al. aimed to build on existing evidence by explor­ing potential correlations. Using a large database, they found that the work of higher-volume cataract surgeons per­forming phacoemulsification resulted in slightly improved visual acuity (VA) outcomes and lower complication rates.

    For this study, the researchers included 35,880 eyes that received small-incision cataract surgery (SICS) or phacoemulsification with intend­ed IOL placement. All surgeries were performed in 2015 at the Aravind Eye Hospital in Madurai, India. Bivariate linear regression with random effects was used to assess each eye’s uncorrect­ed VA (UCVA) at follow-up relative to surgeon case volume and to other demographic and case factors. Factors with a p value below 0.20 on bivariate regression were included in random-effects multivariate regression model­ing. The primary objective was to assess relationships between surgeon case vol­ume and patients’ visual outcomes after cataract surgery. Secondary objectives included exploring potential correla­tions between other case characteristics and VA outcomes and between case volume and complication rates.

    The operations were performed by 69 surgeons; individual case volume for 2015 ranged from 76 to 2,900. In general, higher case volume was inde­pendently associated with a statistically significant (but clinically modest) im­provement in UCVA after phacoemulsi­fication but not after SICS. However, this effect appeared to plateau at a case-load of approximately 350 cases per year. The favorable UCVA trend was not observed for surgeons who performed between 1,501 and 2,000 cases per year; their patients’ visual outcomes were worse than for other surgeon groups, except the lowest-volume cohorts. Higher case volume was associated with significantly lower complication rates with phacoemulsification as well as with SICS. Younger patient age was independently linked to better visual outcomes and lower complication rates with both procedures.

    Greater surgeon experience cor­related with lower complication rates for phacoemulsification but not for SICS. Level of experience did not cor­relate with VA outcomes.

    The findings may help to inform the design and workflow of ophthalmology clinics, said the authors. This might have particular relevance in countries with a large burden of cataract-related visual impairment and a high patient-to-surgeon ratio. (Also see related commentary by Robert J. Campbell, MD, MSc, in the same issue.)

    The original article can be found here.