CATARACT SURGICAL TECHNIQUES - PREFERENCES AND UNDERLYING BELIEFS

To characterize the intraoperative procedures employed by cataract sur geons in the United States and the beliefs underlying the practices, a standardized questionnaire was sent to a systematic random sample of members of the American Academy of Ophthalmology in 1992, Of 667 surve yed ophthalmologists, 550 completed the questionnaire (response rate, 82.5%), Phacoemulsification was used for more than 75% of routine cata ract surgery by 46% of respondents, whereas standard extracapsular sur gery was used for more than 75% of routine cataract surgery by 41% of respondents. Preferential use of phacoemulsification was independently associated with more recent graduation from medical school and higher reported annual surgical volume, Continuous tear capsulotomy was empl oyed by 52% of ophthalmologists. Preference for this technique was ind ependently associated with both the use of phacoemulsification and hig her annual surgical volume. Seventy-one percent of respondents used re trobulbar anesthesia, whereas 28% used peribulbar anesthesia. Use of p eribulbar anesthesia was independently associated with both greater su rgical volume and performance of surgery in an ambulatory surgical cen ter. Beliefs regarding comparative safety and effectiveness were repor ted to influence surgeons' preferences strongly among all of the compe ting techniques studied. Those performing phacoemulsification, in comp arison with those performing extracapsular cataract extraction, report ed that the expectation of reduced astigmatism and shorter recovery ti me strongly influenced their choice of procedure, Variation in preferr ed intraoperative techniques is substantial for cataract surgery and t he beliefs that underlie the preferences, Such variation highlights th e need to determine which techniques maximize patient outcomes and are most cost-effective.