The Auckland Cataract Study II: Reducing Complications by Preoperative Risk Stratification and Case Allocation in a Teaching Hospital

Auckland Cataract Study IV: Practical application of NZCRS cataract risk stratification to reduce phacoemulsification complications

“…In a series of studies over the last 20 years (the Auckland Cataract Studies), the authors among others have noted that, with improved technology and refinement of phacoemulsification techniques, there has been a substantial reduction in intraoperative complications . The use of preoperative risk stratification systems has also been clearly shown to reduce intraoperative complications in cataract surgery .…”

“…In a series of studies over the last 20 years (the Auckland Cataract Studies), the authors among others have noted that, with improved technology and refinement of phacoemulsification techniques, there has been a substantial reduction in intraoperative complications . The use of preoperative risk stratification systems has also been clearly shown to reduce intraoperative complications in cataract surgery . Indeed, in prospective analyses of intraoperative complications of phacoemulsification in the New Zealand public teaching hospital system, using the Muhtaseb risk stratification system, the authors have reported that: (a) higher risk cases can be identified preoperatively and allocated appropriately and (b) intraoperative complications can be reduced by around 40% …”

When is a complication a complication in contemporary cataract surgery?

“…Undoubtedly cataract surgery has become increasingly refined in the last two decades and this progress has been clearly documented at the international and regional levels. Studies such as the Auckland Cataract Study have shown that public hospital intraoperative cataract complication rates which were comparable with the international literature have essentially halved since 2000 and that these risks can be significantly further reduced by the introduction of a simple cataract surgery risk stratification system . However, understanding of key regional population differences also explains higher complication rates due to co‐morbidities such as diabetic retinopathy and glaucoma, advanced cataract or ethnic predisposition, thus improving local consent and surgeon preparedness .…”

“…Studies such as the Auckland Cataract Study have shown that public hospital intraoperative cataract complication rates which were comparable with the international literature 23 have essentially halved since 2000 and that these risks can be significantly further reduced by the introduction of a simple cataract surgery risk stratification system. 24,25 However, understanding of key regional population differences also explains higher complication rates due to co-morbidities such as diabetic retinopathy and glaucoma, advanced cataract or ethnic predisposition, thus improving local consent and surgeon preparedness. 26 As medical professionals there is a strong case for more comprehensive standard pre-and postoperative assessment in on-going objective, quantitative audit as a core approach to benchmark cataract surgery outcomes.…”

Harmonizing cataract surgery training and patient‐centred care in 2020: Disclosure, consent, supervision and patient altruism

“…[1][2][3][4] Nonetheless, even with stratification of risk, complication rates typically remain a little higher for trainees than consultant ophthalmologists in public teaching hospitals. 5,6 Therefore, in the era of patient-centred care (PCC), that is, "Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions," 7 disclosure of trainee involvement during informed consent may impact core aims of teaching hospitals to train surgeons. Indeed, practitioners may be concerned that detailed disclosure of trainee participation, by uncovering patient fears, may reduce the number of possible learning opportunities.…”