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Eric B. Bass, MD, MPH; Phoebe D. Sharkey, PhD; Rajiv Luthra, MD, MPH; Oliver D. Schein, MD, MPH; Jonathan C. Javitt, MD, MPH; James M. Tielsch, PhD; Earl P. Steinberg, MD, MPP

Arch Ophthalmol. 1996;114(9):1121-1127.

Abstract
Objectives
To assess the frequency and content of postoperative 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.

Author Affiliations
From the Departments of Medicine (Drs Bass and Steinberg) and Ophthalmology (Drs Luthra, Schein, and Tielsch), The Johns Hopkins University School of Medicine, and Departments of Health Policy and Management (Drs Bass and Steinberg) and International Health (Dr Tielsch), The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md; Department of Information Systems and Decision Sciences, Sellinger School of Business, Loyola College, Baltimore (Dr Sharkey); and Worthen Center for Eye Care Research, Georgetown University Medical Center, Washington, DC (Dr Javitt).

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