VARIATION IN CATARACT-SURGERY PRACTICE AND CLINICAL OUTCOMES

Purpose: To examine associations between surgical technique, patient a nd surgeon characteristics, and clinical outcomes of cataract surgery. Methods: Seventy-five ophthalmologists were recruited from three citi es based on a sampling scheme stratified by surgeon-reported annual vo lume of cataract surgery. Seven hundred seventy-two patients undergoin g first eye cataract surgery were enrolled, with complete preoperative , perioperative, and 4-month postoperative clinical data on 717 patien ts (93%). Results: Sixty-five percent of surgery was performed by phac oemulsification and 35% by standard extracapsular (ECCE) techniques. P erformance of ECCE was associated with the presence of ocular comorbid ity and 21 or more years in practice of the surgeon. Performance of ph acoemulsification was associated with annual volume of cataract surger y, wherein high-volume (201-399 patients annually) and very high-volum e (>400 patients annually) surgeons had 3.7 and 3.9 times the likeliho od of performing phacoemulsification compared with moderate-volume (51 -200 cases annually) surgeons. The rates of intraoperative, perioperat ive, and 4-month postoperative adverse events and the amount of improv ement in visual acuity did not differ either by surgical technique or volume stratum. The reported occurrence of posterior capsular opacific ation within 4 months of surgery was increased in the presence of cort ical opacification, one city, and patients operated on by either high- or very high-volume surgeons. Conclusions: in this cohort, no differe nce in clinical outcomes, as measured by change in visual acuity or oc currence of postoperative adverse events (except for posterior capsula r opacification), can be attributed to performance of phacoemulsificat ion versus ECCE or to the reported annual volume of cataract surgery o f the surgeon. Self-reported high and very high annual volume of catar act surgery is associated independently with performance of phacoemuls ification and surgeon's report of posterior capsular opacification at 4 months after cataract surgery.