Comparing Resident Outcomes in Cataract Surgery at Different Levels of Experience

Mélega, Mathias Violante; Lira, Rodrigo Pessoa Cavalcanti; Silva, Iuri Cardoso da; Ferreira, Bruna Gil; Filho, Hermano Lucio G. A.; Martini, Alexandre A.F.; Reis, Roberto dos; Arieta, Carlos Eduardo Leite; Alves, Mônica

doi:10.2147/opth.s285967

Cited by 12 publications

(9 citation statements)

References 29 publications

(55 reference statements)

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“…The current study finds no substantial differences in mean complication rates between patients operated on by residents in their first 3 years compared to more experienced peers. However, fourth-year residents show a significantly higher mean complication rate, particularly those involving posterior capsule tear and vitreous loss, similar to former reports [ 13 , 34 , 35 ]. This trend may stem from supervisors who, perceiving well-developed skills in fourth-year residents, may reduce interventions, giving more independence to residents as they gain more experience, and contributing to increased complications.…”

Section: Discussionsupporting

confidence: 89%

Ophthalmology Residents’ Experience in Cataract Surgery: Preoperative Risk Factors, Intraoperative Complications, and Surgical Outcomes

Cnaany,

Goldstein,

Lavy

et al. 2024

Ophthalmol Ther

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Introduction This retrospective study explores the connection between preoperative patient risk factors, the experience of ophthalmology residents, and the outcomes of cataract surgeries performed at Hadassah Medical Center. It is hypothesized that with increased experience, residents may demonstrate greater proficiency in handling surgeries on higher-risk patients, potentially leading to improved surgical outcomes overall. Methods Data were examined from 691 consecutive cataract surgeries in 590 patients, conducted by ophthalmology residents at Hadassah Medical Center (January 2018 to February 2022). Demographics, surgeon experience, preoperative cataract risk assessment score, and pre- and postoperative corrected distance visual acuity (CDVA) were analyzed. The risk score was based on cataract density, previous vitrectomy, presence of phacodonesis, small pupil, extreme axial length (> 30 mm or < 21.5 mm) or abnormal axial length (26–30 mm), shallow anterior chamber (< 2.5 mm), poor patient cooperation, oral alpha-1 blocker use, diabetic retinopathy (DR), Fuchs endothelial dystrophy, and having one functioning eye. This study focused on the correlation of risk scores with residents’ surgical experience and surgical outcomes. Results As residents gained experience, surgeries on patients with at least one risk factor increased from 54% (first year) to 75% (second year; p < 0.001) and fluctuated between 75%, 82%, and 77% (third, fourth, and fifth years, respectively), with initial preoperative CDVA declining progressively. Despite handling more complex cases over time, the percentage of intraoperative complications per patient decreased with each year of residents’ experience (17%, 13%, 11%, 17%, 6%; respectively). Patients without any risk factor had higher postoperative CDVA than those with one or more risk factors (mean ± standard deviation [SD] in logMAR, 0.16 ± 0.26 vs. 0.27 ± 0.35; p < 0.001) and a higher percentage of CDVA improvement (63% vs. 57%, p = 0.016). Conclusions The use of a preoperative risk assessment scoring system to allocate surgeries to residents at varying experience levels may reduce the risk for surgical complications, thereby ensuring patient safety and providing residents with a gradual learning experience. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-024-00947-6.

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Section: Discussionsupporting

confidence: 89%

Ophthalmology Residents’ Experience in Cataract Surgery: Preoperative Risk Factors, Intraoperative Complications, and Surgical Outcomes

Cnaany,

Goldstein,

Lavy

et al. 2024

Ophthalmol Ther

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“…These findings support 1 recent singleinstitution study finding that more surgical experience led to reduced intraoperative complications for cataract surgeries but seems to contrast another study that found no significant differences in interoperative complication rates between second and third year ophthalmology residents. 28,29 This latter study, however, did not observe how intraoperative complications changed with increased surgical volume and was an experience of 1 institution.…”

Section: Discussionmentioning

confidence: 90%

Resident involvement in cataract surgery at the Veterans Health Administration: complications, case complexity, and the role of experience

Aggarwal

Wisely

Pepin

et al. 2023

J Cataract Refract Surg

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“… 10 This is attributed to our cohort being comprised of complex cataract cases which are likely to have greater rates of complications. In a retrospective study by Melega et al 11 analyzing the outcomes of cataract surgeries by ophthalmology residents, the complication rates gradually decreased from (23.53%) in the first-semester group, 20.93% in the second-semester group, and 11.31% in the third and final semester group. However, we did not find any such difference in the complication rates as far as surgical experiences were concerned.…”

Section: Discussionmentioning

confidence: 98%

“…Traditionally, cataract surgeries with complexities or ocular associations have been conveniently excluded from most of the earlier studies. 4 , 10 , 11 Here, we had specifically targeted the difficult “complex” cataract surgeries where the performances of the fellows were not evaluated in the literature so far.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of “Complex” Cataract Surgeries Performed by Long-Term Glaucoma Fellows in a Tertiary Eye Centre from Eastern India

Roy¹,

Almeida²,

Rao³

2023

OPTH

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Purpose To evaluate the outcomes of operating on “complex cataracts” by the glaucoma fellows. Patients and Methods This was a retrospective study done at a tertiary referral eye care centre in eastern India. After obtaining IRB approval, a retrospective chart review of all patients who underwent “complex” cataract surgery by one of four long-term (2 years) glaucoma fellows between January 2016 and November 2020 was conducted. ‘Complex’ was defined as cataracts complicated with pseudoexfoliation syndrome, phacodonesis with or without blunt ocular trauma, posterior polar cataract, small pupil, co-existent corneal opacity or uveal coloboma, post-glaucoma filtering surgery, post-vitreoretinal surgery, co-existent glaucoma or post-laser iridotomy and monocular patients. Results Out of a total of 677 eyes done by the glaucoma fellows during the study period, 83 eyes had complex cataract surgery and completed the six-week post-operative follow-up. Intraoperative surgical complications like posterior capsular rent or vitreous loss were noted in 36 of the cases. Thirty of the eyes were left aphakic. Despite a high rate of complications, the LogMAR best-corrected visual acuity (mean ± standard deviation) improved from the preoperative level of 1.7 (±0.5) to 1.0 (± 0.8) at post-operative six weeks, significant at p < 0.001. As far as the surgeon’s experience was concerned—less than or more than a year since joining the fellowship—there was statistically no difference in the final visual acuity. The group with greater experience had shorter surgical time and lesser complications though this difference was not statistically significant. Conclusion This is the first study in the literature reporting the outcomes of “complex” cataract surgery performed by glaucoma fellows. Though high rates of postoperative complications were noted in this study, the mean best-corrected visual acuity improved significantly in all eyes after the surgery.

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Comparing Resident Outcomes in Cataract Surgery at Different Levels of Experience

Cited by 12 publications

References 29 publications

Ophthalmology Residents’ Experience in Cataract Surgery: Preoperative Risk Factors, Intraoperative Complications, and Surgical Outcomes

Ophthalmology Residents’ Experience in Cataract Surgery: Preoperative Risk Factors, Intraoperative Complications, and Surgical Outcomes

Resident involvement in cataract surgery at the Veterans Health Administration: complications, case complexity, and the role of experience

Outcomes of “Complex” Cataract Surgeries Performed by Long-Term Glaucoma Fellows in a Tertiary Eye Centre from Eastern India

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