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Visual Acuity Outcomes after Cataract Surgery: High-Volume versus Low-Volume Surgeons
Jacob T Cox1, Ganesh-Babu B Subburaman2, Beatriz Munoz1
1Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland.
Ophthalmology
|April 12, 2019
Summary
High-volume cataract surgeons performing phacoemulsification cataract extraction (PECE) demonstrated improved visual acuity and fewer complications. This supports high-output clinics, especially in developing nations with many untreated cataracts.
Area of Science:
- Ophthalmology
- Surgical Outcomes
- Public Health
Background:
- Cataract surgery is a common procedure globally.
- Surgeon experience and case volume are potential factors influencing surgical outcomes.
- Optimizing cataract surgery delivery is crucial, especially in resource-limited settings.
Purpose of the Study:
- To investigate the association between annual surgeon case volume and visual acuity outcomes after cataract surgery.
- To examine the relationship between surgeon case volume and complication rates.
- To identify other patient and case characteristics affecting visual acuity outcomes.
Main Methods:
- A retrospective database study of adult cataract surgeries (small-incision cataract surgery [SICS] and phacoemulsification cataract extraction [PECE]) performed in 2015.
- Analysis of 35,980 eyes from 69 surgeons with varying annual case volumes.
- Statistical analysis using bivariate and multivariate linear regression with random effects modeling to assess outcomes relative to surgeon volume and patient factors.
Main Results:
- Increasing annual surgeon case volume was linked to modest improvements in uncorrected visual acuity (UCVA) for PECE but not SICS.
- The most significant improvements in PECE were seen when comparing surgeons with ≤350 cases/year.
- Higher annual case volume correlated with significantly lower complication rates for both PECE and SICS. Younger patient age was associated with better outcomes and fewer complications.
- Greater surgeon experience showed a link to lower PECE complication rates but not SICS outcomes.
Conclusions:
- High-volume cataract surgeons achieve better visual acuity outcomes in PECE and lower complication rates in both PECE and SICS.
- Findings support the efficiency of high-output ophthalmology models, particularly beneficial in developing countries facing high cataract burdens.
- This highlights the importance of surgeon volume in optimizing cataract surgery delivery and patient outcomes.
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