Postoperative management of cataract surgery patients by ophthalmologists and optometrists
E. B. Bass, P. D. Sharkey, R. Luthra, O. D. Schein, J. C. Javitt, J. M. Tielsch and E. P. Steinberg
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md, USA.
OBJECTIVES: To assess the frequency and content of post-operative
examinations by ophthalmologists and optometrists for cataract surgery
patients without operative complications and to assess the referral
patterns of optometrists when complications are identified. DESIGN: In 1992
we conducted a survey of randomly selected members of the American Academy
of Ophthalmology and American Optometric Association. Responses were
obtained from 538 (82%) of 655 eligible ophthalmologists and 130 (84%) of
154 eligible optometrists. RESULTS: Eighty-eight percent of responding
ophthalmologists reported that patients had 4 or more visits within 4
months after surgery, 97% of ophthalmologists performed the first
postoperative examination on their cataract surgery patients, and 60% of
ophthalmologists reported that no other eye professional saw their patients
postoperatively. Forty-six percent of responding optometrists participated
in postoperative care of cataract surgery patients, and usually performed
their first postoperative examination 7 days after surgery; 78% of these
optometrists reported that they saw patients 3 or more times after surgery.
Postoperatively, 83% of ophthalmologists and 75% of optometrists usually
performed at least 1 dilated fundus examination, 87% of ophthalmologists
and 47% of optometrists performed 4 or more slit-lamp examinations, 74% of
ophthalmologists and 42% of optometrists performed 4 or more tonometry
tests, and 83% of both groups performed 2 or more refractions. More than
80% of responding optometrists involved in postoperative care of cataract
surgery patients immediately refer a patient to an ophthalmologist if there
is evidence of acute glaucoma or an unexplained decrease in vision in the
eye that was operated on. For less urgent complications, most optometrists
promptly make a referral to an ophthalmologist. CONCLUSIONS: In 1992, a
small percentage of ophthalmologists and optometrists were performing fewer
follow-up examinations and tests for cataract patients than recommended by
the American Academy of Ophthalmology. Not all optometrists immediately
refer to an ophthalmologist any acute complication that they identify
postoperatively.
