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Survey provides insight into Australian cataract surgery landscape

A new cataract surgery survey conducted through RANZCO has reaffirmed the gulf between the private and public systems, as well as a snapshot of surgeons’ perceptions of Snellen acuity and controversial simultaneous bilateral cataract procedures.

Leading Australian cataract surgeon Professor Gerard Sutton and Chris Hodge PhD, a clinical research coordinator at the Vision Eye Institute, recently distributed a short pilot questionnaire to gain a greater understanding of the local cataract surgery landscape, which they hope will inform further discussion on best practice.

Prof Gerard Sutton.

In an article published in RANZCO’s latest Eye2Eye magazine, they said 194 Fellows responded to their survey, with the majority (86.1%) performing the largest share of procedures within private practice.

According to the findings, private surgeons reported less waiting time for patients, with 96.9% indicating they could proceed to surgery within two months. This was compared with only 1.5% of patients in the public domain.

Further, 44.9% of public surgeons suggested that patients may wait between six to 12 months and 41.8% at least one year.

The use of Snellen acuity – and how much weight it should have in the prioritisation of cataract surgery – was also canvassed in the survey.

Noting it was an “inadequate tool”, Sutton and Hodge said that while 45.9% of respondents agreed Snellen acuity may be considered one part of an assessment to prioritise surgery lists, most respondents (80.4%) indicated 6/12 is not the most important determinant for surgical intervention.

“This finding appears to reflect global guidelines which do not place a hard limit on corrected visual acuity prior to undertaking surgery,” they wrote in the article.

“The number of available, validated quailty of vision questionnaires has increased in recent years, potentially providing more information on subjective complaints. Although only 8.3% suggested these are used routinely, 41.7% confirmed the use of their own non-standardised questions focussing on patient visual-based limitations in daily life.”

The duo also quizzed Australian ophthalmologists on their views about simultaneous bilateral cataract surgery (SBCS), which appears to have a limited local uptake.

Although it remains contentious, Sutton and Hodge point out it has become more prevalent in in Northern Europe with government compensation for day surgeries.

“Proponents may argue that the incidence of bilateral endophthalmitis is minimal, however it remains a primary concern for many,” they wrote.

“SBCS is undertaken in Australia, however our survey suggests it has minimal penetration at present with only 4.1% of respondents offering the service to patients. Furthermore, 95.4% of surgeons did not believe SBCS should be made mandatory as an alternate to routine practice of surgery on separate days. Of note, of those who complete SBCS, most surgeons (69%) only offered it to 5-10% of their patients, highlighting the current niche role in the patient/surgery discussion.”

The survey also covered the use of intracameral (I/C) antibiotics during cataract surgery. The latest issue of Eye2Eye can be found here.

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