Understanding ophthalmologists' perspectives on the risk of cataract surgery

Cataract surgery is one of the most common elective surgeries and has been shown to be safe with low adverse event rates. Most cataract patients in the US receive one-to-one intraoperative monitoring and sedation administered by an anesthesiologist or nurse anesthetist, termed "monitored anesthesia care" (MAC). Recent studies have suggested that non-anesthesia-led sedation approaches may safely be used in older adults undergoing cataract surgery. However, it is unknown how individual ophthalmologists perceive the risks of cataract surgery with respect to the need for MAC. We sought to characterize physician beliefs and opinions about the risks of performing cataract surgery when considering potential non-anesthesia-led approaches to cataract surgery sedation.

Using a semi-structured interview guide developed with the Consolidated Framework for Implementation Research (CFIR) framework, between December 2022 and May 2023, we conducted virtual interviews with ophthalmologists who routinely performed cataract surgeries in the United States with or without anesthesia care in outpatient clinical settings across the continental US. Data were analyzed from June 2023 through January 2024 using an inductive thematic analysis approach.

Interviews of 19 ophthalmologists revealed 2 major themes that formed the foundational understanding of how ophthalmologists perceive cataract surgery risk in the context of non-anesthesia-led models of sedation: (1) overall safety of cataract surgery and (2) concerns about assuming sedation responsibilities. Despite conceding that cataract surgery is a low-risk procedure for the vast majority of patients, participants were hesitant to change their current practice and desired an anesthesia "safety net" at all times in case of an unexpected intraoperative event or emergency. Many ophthalmologists' responses underscored their aversion to any potential loss of routine anesthesia support without an acceptable alternative present.

Despite acknowledging its low-risk profile, ophthalmologists are wary of making changes to current sedation approaches for routine cataract surgery.