Resident and young physician experience with complex cataract surgery and new cataract and refractive technology: Results of the ASCRS 2016 Young Eye Surgeons survey

Schallhorn, Julie M.; Ciralsky, Jessica; Yeu, Elizabeth

doi:10.1016/j.jcrs.2017.04.022

Cited by 7 publications

(7 citation statements)

References 19 publications

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“…This suggests that a minimum of 10 cases is required to feel confident using nonstandard techniques or devices. 9 Our review of third-year resident cataract surgery experience at our institution's VA hospital revealed that complex cataracts constituted a minimal portion of the cases. On average, only 4.5% of cases were complex.…”

Section: Discussionmentioning

confidence: 97%

Ophthalmology Residents' Experience with Complex Cataract Surgery at a VA Hospital over 10 Years

et al. 2020

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Objective The purpose of this study was to determine the proportion of complex cataract surgery performed by third-year ophthalmology residents at an academic Veterans Administration Medical Center. Methods A chart review was conducted of all resident cataract surgeries performed at the James J. Peters Veterans Administration Medical Center in The Bronx, NY between July 1, 2007, and June 30, 2017. Correct categorization was confirmed by review of operative report and reason for complex categorization was recorded, as well as the use and type of nonstandard device or technique. Results A total of 2,429 routine and 114 complex cataract surgeries were performed by 40 different residents over the 10-year period. In total, 4.5% of all cataract surgeries were categorized as complex. The most common reasons for complex categorization included intraoperative floppy iris syndrome (35.8%), miosis (38.4%), zonular instability (9.6%), mature cataract (7%), posterior synechiae (7.8%), and posterior capsular plaque (1.8%). Nonstandard techniques/devices included iris hooks (65.3%), pupil expansion device (8.5%), extracapsular cataract extraction (6.8%), synechiolysis (7.6%), mechanical iris dilation (0.8%), capsular tension ring (9.3%), and primary posterior continuous curvilinear capsulorhexis (1.7%). Conclusion A review of third-year resident cataract surgery experience at our institution's VA hospital where a significant amount of their surgical volume, approximately 50%, is obtained revealed that complex cataracts constituted a minimal portion of the cases. Education in cataract surgery should be competency based, extend beyond achieving minimums, and focus on variety and complexity of surgical experience. Formal tracking of routine versus complex cases should be considered to optimize training experience and assure patient safety.

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Section: Discussionmentioning

confidence: 97%

Ophthalmology Residents' Experience with Complex Cataract Surgery at a VA Hospital over 10 Years

et al. 2020

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“…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%

“…Data during their 2 months of secondary center posting were not included in the present study. The cataract case was defined as complex 10 if one or more of the following factors were present— Small pupil Pseudoexfoliation material around the pupil or lens capsule Post-traumatic Post-vitreoretinal surgery Post-glaucoma filtering surgery Central corneal opacity Phacodonesis due to any cause like trauma Co-existent glaucoma or post-laser iridotomy Posterior polar cataract Cataract with uveal coloboma Monocular patient. …”

Section: Methodsmentioning

confidence: 99%

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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“…3 When considering both trainee surgeons as well as surgeons in their first 5 years of practice, a 2017 study reported only 39% of respondents had performed ATIOL surgery. 4 These data suggest an increasing adoption of ATIOL surgeries among practicing surgeons for which a structured ATIOL curriculum may uniquely benefit surgeons in training.…”

Section: Introductionmentioning

confidence: 93%

<p>Surgical Curriculum for Presbyopia-Correcting Intraocular Lenses: Resident Experiences and Surgical Outcomes</p>

Riaz¹,

Williams²,

Farooq³

et al. 2020

OPTH

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Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/OHbPTPD6Kjw Objective: To describe a stepwise surgical curriculum that was implemented to teach novice surgeons about currently available advanced technology intraocular lenses (ATIOLs) for correction of presbyopia and to report the experiences and surgical results of ATIOL surgery performed by residents who engaged in the curriculum. Design, Setting, and Participants: Third-year ophthalmology residents participated in a curriculum incorporating didactic lectures (with objective assessment and wet-lab practice) and observation of attending-performed ATIOL surgeries prior to performing ATIOL surgery as primary surgeon under direct supervision. Post-operative outcomes studied were best corrected distance visual acuity (BCDVA) and uncorrected distance (UDVA), intermediate (UIVA) near (UNVA) visual acuity and correction of astigmatism with at least 3 months of follow-up (POM3+). Residents were also given a survey to assess experiences with the surgical curriculum, preparedness for use of ATIOLs post-residency, and ATIOL practice pattern post-residency. Results: A total of 12 residents from four consecutive classes completed the curriculum. Residents overall had a favorable opinion of the curriculum and felt well prepared to use ATIOLs after training. Graduates who currently perform cataract surgery felt comfortable using all available ATIOLs. A total of 100 eyes from 72 patients met the inclusion criteria for analysis in the study. At the POM3+ timepoint, 88% of eyes had UDVA of 20/30 or better, 93% had UIVA of 20/30 or better, and 71.2% had UNVA of 20/30 (J2) or better. Among eyes that received an astigmatism-correcting ATIOL, 91% had <1 diopter of astigmatism after surgery. Conclusion: Resident surgeons learned to perform ATIOL surgery (medical knowledge) and achieve strong surgical outcomes (patient care) with all currently available ATIOLs after completion of a stepwise curriculum. Educators may be encouraged to incorporate an ATIOL curriculum based on the results of this study. The curriculum presented is a prototype and may be further improved with future experiences and studies.

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Resident and young physician experience with complex cataract surgery and new cataract and refractive technology: Results of the ASCRS 2016 Young Eye Surgeons survey

Cited by 7 publications

References 19 publications

Ophthalmology Residents' Experience with Complex Cataract Surgery at a VA Hospital over 10 Years

Ophthalmology Residents' Experience with Complex Cataract Surgery at a VA Hospital over 10 Years

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

<p>Surgical Curriculum for Presbyopia-Correcting Intraocular Lenses: Resident Experiences and Surgical Outcomes</p>

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