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  • Tracking the Cataract Surgery Learning Curve

    By Mary Brophy Marcus
    Selected by Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, May 2023

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    By 2050, an estimated 50 million or more Americans will develop cataracts. As demand for cataract surgery grows, the need for competent surgeons will intensify. To better understand the early cataract learning curve among residents, Balas et al. tracked resident progress over the course of cataract sur­gery training by measuring procedural speed and the frequency of specific actions as a surrogate for competency and skill progression. They found that a basic level of surgical competency was achieved after 80 cases—but that advancement toward surgical finesse occurs after 300 cases.

    For this longitudinal panel study, the researchers collected video recordings of 100 cataract surgeries performed by the same resident between 2021 and 2022. The videos ranged from the resi­dent’s sixth to 760th case. The start and end times of 19 distinct operative phases of cataract surgery were manu­ally labeled by a trained annotator. For each action throughout the resident’s first year of training, time series anal­ysis was used to measure the direction and magnitude of trends in the resi­dent’s surgical speed.

    The median total time for each video was 11.6 minutes (interquartile range [IQR], 10.1-14.4 minutes), with the overall speed increasing at a rate of 43.4 seconds for every 10 videos (95% CI, 35.1 to 52.7 seconds). The time for nine operative phases decreased significantly throughout the training. The greatest improvements in speed relative to aver­age procedural times occurred during phacoemulsification and hydrodissec­tion. On average, 26.9 distinct operative actions (not including idle periods) took place in each video.

    According to the authors, this is the first effort to derive cataract surgery learning curves for all relevant opera­tive actions. They noted that the 80 case milestone for basic cataract surgery competency is consistent with the find­ings of previous investigations.

    The original article can be found here.