The largest study of contemporary phacoemulsification cataract surgery outcomes in Australia has highlighted concerns that surgeons in a public setting are increasingly seeing more complex cases from lower-socioeconomic patients.
And the researchers believe government policymakers and hospital administrators need to consider this when creating health policy to fund existing services and increasing service provision in the future.
The major review of cataract surgery from 5018 consecutive cases at Sydney’s Westmead Hospital between May 2017 and August 2020, found just under half of the patients treated were “more complex cases with a higher burden of co-existing ocular pathology”.
At 48.9%, “this is one of the highest rates reported when compared to equivalent Western nations: significantly more than the UK Royal College of Ophthalmologists National Ophthalmic Database (36.9%), the Swedish National Cataract Registry (33%) or the American Academy’s Intelligent Research in Sight registry (35.4%).
The researchers, Dr Muhammad A Khan, Dr Brendon W H Lee, Dr Lauren Sartor, and Associate Professor Chameen Samarawickrama, said the shift highlighted the “heterogenicity of cataract surgery cohorts based on location”.
“Our institution services approximately 1.2 million Australians, with a high referral rate from lower socioeconomic areas where patients tend to have multiple comorbidities, present late in the disease process, and have significant pathology at presentation.
“This is compounded by the significantly longer median waiting time for cataract surgery at our institution’s health district compared with national waiting times (330 days vs 98 days in 2019, respectively), which have further been exacerbated secondary to COVID-19 lockdowns, restrictions in elective surgery, the resultant backlog of cases.”
As part of their research, the electronic medical record system was used to review three time-points for all phacoemulsification cataract surgeries at Westmead Hospital: preoperative, intraoperative and one-month postoperatively. Variables collected included uncorrected distance visual acuity (UDVA) and pinhole visual acuity, surgeon seniority and ocular pathology.
Of the 5018 eyes, 37.3% were operated on by consultants, 47.1% by trainees and 15.6% by fellows.
Ocular pathology was seen in 48.9% of eyes. The mean preoperative and one-month postoperative UDVA was 6/48 and 6/12, respectively. There was an intraoperative complication in 7.6% of eyes and posterior capsular rupture (PCR) occurred in 2.7%. PCR rates between consultants (3.1%), trainees (2.6%) and fellows (2.1%) showed no statistically significant difference. The key risk factors for PCR were advanced cataract, alpha-antagonist use, small pupil size and the presence of glaucoma.
The researchers said the visual and surgical outcomes were comparable to previous Australian reports and outcomes reported from international teaching hospitals.
They also felt that the lack of a regional cataract surgery registry represented a critical need in assessing and claiming key performance indicators, capturing emerging trends and identifying region-specific risk factors to deliver the best patient outcomes.
“Thus regional benchmarks can only be determined through literature review.”
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