Auckland Cataract Study III: Refining Preoperative Assessment With Cataract Risk Stratification to Reduce Intraoperative Complications

Han, Jina; Patel, Dipika V.; Wallace, Henry B.; Kim, Bia Z.; Sherwin, Trevor; McGhee, Charles N J

doi:10.1016/j.ajo.2019.01.013

Cited by 8 publications

(9 citation statements)

References 6 publications

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“…Moreover, the use of risk stratification system prior to cataract surgery is widely accepted and practiced with small variations around the world (1). For example, it has been suggested that the Buckinhamshire risk assessment better correlates with post-operative complications, while the Muhtaseb variation is more accurate in predicting intraoperative complications (28).…”

Section: Discussionmentioning

confidence: 99%

Cataract complications study: an analysis of adverse effects among 14,520 eyes in relation to surgical experience

Aaronson¹,

Kanclerz²,

Grzybowski³

et al. 2020

Ann Transl Med

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Section: Discussionmentioning

confidence: 99%

Cataract complications study: an analysis of adverse effects among 14,520 eyes in relation to surgical experience

Aaronson¹,

Kanclerz²,

Grzybowski³

et al. 2020

Ann Transl Med

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“…One of the most evaluated strategies to assess complication risks is that proposed by Muhtaseb et al that considered the most common complications and risk factors reported previously (8). This method has been successfully adopted by the Auckland Cataract Study (5)(6)(7)(8)(9)(10) and modified by the same group in 2019 (4,27).…”

Section: Discussionmentioning

confidence: 99%

Application of Artificial Intelligence in the Analysis of Features Affecting Cataract Surgery Complications in a Teaching Hospital

et al. 2020

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Aims: To evaluate the ocular and systemic factors involved in cataract surgery complications in a teaching hospital using artificial intelligence.Methods: One eye of 1,229 patients with a mean age of 70.2 ± 10.3 years old that underwent cataract surgery was selected for this study. Ocular and systemic details of the patients were recorded and then analyzed by means of artificial intelligence. A total of 1.25 billion simulations of artificial intelligence learning and testing were conducted on several variables and a customized model of analysis was developed.Results: A total of 73 complications were recorded in this study. According to the analysis performed, the main factors involved in cataract surgery complications were: a surgeon in training, axial length and intraocular lens power. The model predicted how long surgery would last with an error of <6 min compared to the effective time needed.Conclusions: According to the data here obtained, artificial intelligence could be an interesting option to build customized models able to prevent complications and to predict actual surgery time. The customized algorithm option allows the development of better models adaptable to different units as well as the possibility to be calibrated for the same unit along time.

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“…We believe the findings of this study should justify adding the low BCVA criterion to current stratification methods. 4 Interestingly, there has been a dramatic shift in cataract operations from being performed in public hospitals to private settings. 1 Simultaneously, an increase in the number of high-volume cataract surgeons and overall decrease in capsule complications were observed.…”

mentioning

confidence: 99%

Re: Zetterberg et al.: A composite risk score for capsule complications based on data from the Swedish National Cataract Register: relation to surgery volumes (Ophthalmology. 2020 Jul 22 [Epub ahead of print])

Tuuminen

Grzybowski

Kanclerz³

2021

Ophthalmology

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TO THE EDITOR: We read the article by Zetterberg et al 1 in which the authors investigated the association between the risk of capsule complications in cataract surgery and patient demographics, ocular comorbidity and intraoperative difficulties. The study analyzed the case mix, determined the odds ratios (ORs) for capsule complications, and created the composite risk scores from adjusted ORs of preoperative and intraoperative risk factors based on the outcomes of 118 534 cataract surgeries conducted in 2016 and coded in the Swedish National Cataract Register. The authors report that patients with a low best-corrected visual acuity (BCVA) had a significantly higher risk of capsular complications; the OR was 1.67 (95% confidence interval [CI], 1.46e1.90) for a BCVA of <0.5, and 3.21 (95% CI, 2.66e3.87) for a BCVA of 0.1. This finding seems to be critical; in some countries, for example, in Finland (BCVA of 0.5 in the better eye, and 0.3 in the worse eye) and in Poland (BCVA of 0.6), access to treatment for cataracts covered by public funds is restricted only to patients with a low BCVA. 2 The data from the study by Zetterberg et al not only support the opinion that BCVA should not be the sole criterion when selecting patients for surgical treatment, 3 but also shows that such an approach might lead to a higher risk of complications. Moreover, these results confirm the concept that cataract surgery guidelines should not encourage postponing surgery. 2 As the authors present, risk stratification or allocation of patients with appropriate risk profiles to surgeons in training versus experienced consultants would be beneficial. We believe the findings of this study should justify adding the low BCVA criterion to current stratification methods. 4 Interestingly, there has been a dramatic shift in cataract operations from being performed in public hospitals to private settings. 1 Simultaneously, an increase in the number of high-volume cataract surgeons and overall decrease in capsule complications were observed. 1 Further analysis of the impact of clinical setting on case mix and complication rates may guide the decisions whether cataract surgeries should be referred to specialized units, such as ambulatory surgery centers. These specialized units may also better implement simple patient medical records compared to heavy programs in the full-provider units in general hospitals. 5 With that, several studies have presented advantages associated with surgeries performed in ambulatory surgery centers: better patient satisfaction, enhanced surgeon productivity, lower cost for the insurer or patient. 5

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Auckland Cataract Study III: Refining Preoperative Assessment With Cataract Risk Stratification to Reduce Intraoperative Complications

Cited by 8 publications

References 6 publications

Cataract complications study: an analysis of adverse effects among 14,520 eyes in relation to surgical experience

Cataract complications study: an analysis of adverse effects among 14,520 eyes in relation to surgical experience

Application of Artificial Intelligence in the Analysis of Features Affecting Cataract Surgery Complications in a Teaching Hospital

Re: Zetterberg et al.: A composite risk score for capsule complications based on data from the Swedish National Cataract Register: relation to surgery volumes (Ophthalmology. 2020 Jul 22 [Epub ahead of print])

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