Learning Curve Differences in a Novice Cataract Surgeon: Comparing Femtosecond Laser-assisted and Conventional
Giacomo Branger1, Raphael Fritsche1, Michael Thiel1
1Ophthalmology, Cantonal Hospital Lucerne, Switzerland.
Abstract:
PURPOSE: To evaluate the development of operating time (OT) and effective phacoemulsification time (EPT) in cataract surgery performed by a novice cataract surgeon, comparing femtosecond laser-assisted cataract surgery (FLACS) with conventional phacoemulsification cataract surgery (CPCS). A subgroup analysis based on nucleus cataract grading (WHO grading system) and chronological surgical experience (quartiles) was conducted.
Abstract:
METHODS: A retrospective analysis was performed on the first 426 cataract surgeries, comprising 95 FLACS and 331 CPCS. Each cohort was divided into four chronological quartiles to assess the learning curve. Outcomes were analysed according to nucleus cataract grades 0 - 3 and 9. The primary endpoints were OT and EPT.
Abstract:
RESULTS: Both techniques demonstrated significant improvement in operating efficiency over time. In the FLACS group; the median OT decreased from 23 min in the first quartile to 15 min in the fourth quartile. Median EPT concurrently decreased from 2.2 s to 0.6 s. In the CPCS group, the median OT improved from 26 min to 15 min, while median EPT declined from 7.0 s to 1.6 s across quartiles. In subgroup analyses of nucleus grades 1 and 2, OT and EPT tended to converge between FLACS and CPCS.
Abstract:
CONCLUSION: Both FLACS and CPCS demonstrated a reduction in overall OT and EPT with growing surgeon experience, reflecting a clear learning curve. While the FLACS group maintained consistently lower EPT throughout, the difference in OT diminished over time and was no longer present in the final quartile. The number of FLACS cases was significantly lower, yet a comparable learning curve was observed-likely because cases from both groups occurred during the same time period, with substantial overlap between the two surgical techniques. In particular, the significantly shorter phaco time in the FLACS group in the first quartile indicates that the FLACS technique may help to reduce the surgical stress on the ocular structures of the eye, especially in the early phase of the training.
