Cataract surgical techniques. Preferences and underlying beliefs
O. D. Schein, E. B. Bass, P. Sharkey, R. Luthra, J. M. Tielsch, J. C. Javitt and E. P. Steinberg
Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Department of Ophthalmology, Baltimore, Md, USA.
To characterize the intraoperative procedures employed by cataract surgeons
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 surveyed
ophthalmologists, 550 completed the questionnaire (response rate, 82.5%).
Phacoemulsification was used for more than 75% of routine cataract surgery
by 46% of respondents, whereas standard extracapsular surgery 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 employed by 52% of
ophthalmologists. Preference for this technique was independently
associated with both the use of phacoemulsification and higher annual
surgical volume. Seventy-one percent of respondents used retrobulbar
anesthesia, whereas 28% used peribulbar anesthesia. Use of peribulbar
anesthesia was independently associated with both greater surgical volume
and performance of surgery in an ambulatory surgical center. Beliefs
regarding comparative safety and effectiveness were reported to influence
surgeons' preferences strongly among all of the competing techniques
studied. Those performing phacoemulsification, in comparison with those
performing extracapsular cataract extraction, reported that the expectation
of reduced astigmatism and shorter recovery time strongly influenced their
choice of procedure. Variation in preferred intraoperative techniques is
substantial for cataract surgery and the beliefs that underlie the
preferences. Such variation highlights the need to determine which
techniques maximize patient outcomes and are most cost-effective.
