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Cataract Surgical Techniques: Preferences and Underlying Beliefs

Cataract Surgical Techniques: Preferences and Underlying Beliefs Abstract To characterize the intraoperative procedures employed by cataract surgeons in the United States and the beliefs underlying the practices, a standardized questionnaire was sent to a systematic random sample of members of the American Academy of Ophthalmology in 1992. Of 667 surveyed ophthalmologists, 550 completed the questionnaire (response rate, 82.5%). Phacoemulsification was used for more than 75% of routine cataract surgery by 46% of respondents, whereas standard extracapsular surgery was used for more than 75% of routine cataract surgery by 41% of respondents. Preferential use of phacoemulsification was independently associated with more recent graduation from medical school and higher reported annual surgical volume. Continuous tear capsulotomy was employed by 52% of ophthalmologists. Preference for this technique was independently associated with both the use of phacoemulsification and higher annual surgical volume. Seventy-one percent of respondents used retrobulbar anesthesia, whereas 28% used peribulbar anesthesia. Use of peribulbar anesthesia was independently associated with both greater surgical volume and performance of surgery in an ambulatory surgical center. Beliefs regarding comparative safety and effectiveness were reported to influence surgeons' preferences strongly among all of the competing techniques studied. Those performing phacoemulsification, in comparison with those performing extracapsular cataract extraction, reported that the expectation of reduced astigmatism and shorter recovery time strongly influenced their choice of procedure. Variation in preferred intraoperative techniques is substantial for cataract surgery and the beliefs that underlie the preferences. Such variation highlights the need to determine which techniques maximize patient outcomes and are most cost-effective. References 1. Powe NR, Schein OD, Gieser SC, et al, for the Cataract Patient Outcome Research Team. Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation . Arch Ophthalmol . 1994;112:239-252.Crossref 2. Leaming DV. Practice styles and preferences of ASCRS members—1992 survey . J Cataract Refract Surg . 1993;19:600-606.Crossref 3. Steinberg EP, Bass EB, Luthra R, et al, for the Cataract Patient Outcome Research Team. Variation in ophthalmic testing prior to cataract surgery: results of a national survey of ophthalmologists . Arch Ophthalmol . 1994;112:896-902. 902.Crossref 4. Hollander M, Wolfe D. Nonparametric Statistical Methods . New York, NY: John Wiley & Sons Inc; 1973. 5. Schein OD, Steinberg EP, Javitt JC, et al. Variation in cataract surgery practice and clinical outcomes . Ophthalmology . 1994;101:1142-1152.Crossref 6. Hodgkins PR, Luff AJ, Morrell AJ, Teye Botchway L, Featherston TJ, Fielder AR. Current practice of cataract extraction and anaesthesia . Br J Ophthalmol . 1992;76:324-326. 7. Courtney P. The national cataract surgery survey, I: method and descriptive features . Eye . 1992;6:487-492.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1995.01100090030018
Publisher site
See Article on Publisher Site

Abstract

Abstract To characterize the intraoperative procedures employed by cataract surgeons in the United States and the beliefs underlying the practices, a standardized questionnaire was sent to a systematic random sample of members of the American Academy of Ophthalmology in 1992. Of 667 surveyed ophthalmologists, 550 completed the questionnaire (response rate, 82.5%). Phacoemulsification was used for more than 75% of routine cataract surgery by 46% of respondents, whereas standard extracapsular surgery was used for more than 75% of routine cataract surgery by 41% of respondents. Preferential use of phacoemulsification was independently associated with more recent graduation from medical school and higher reported annual surgical volume. Continuous tear capsulotomy was employed by 52% of ophthalmologists. Preference for this technique was independently associated with both the use of phacoemulsification and higher annual surgical volume. Seventy-one percent of respondents used retrobulbar anesthesia, whereas 28% used peribulbar anesthesia. Use of peribulbar anesthesia was independently associated with both greater surgical volume and performance of surgery in an ambulatory surgical center. Beliefs regarding comparative safety and effectiveness were reported to influence surgeons' preferences strongly among all of the competing techniques studied. Those performing phacoemulsification, in comparison with those performing extracapsular cataract extraction, reported that the expectation of reduced astigmatism and shorter recovery time strongly influenced their choice of procedure. Variation in preferred intraoperative techniques is substantial for cataract surgery and the beliefs that underlie the preferences. Such variation highlights the need to determine which techniques maximize patient outcomes and are most cost-effective. References 1. Powe NR, Schein OD, Gieser SC, et al, for the Cataract Patient Outcome Research Team. Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation . Arch Ophthalmol . 1994;112:239-252.Crossref 2. Leaming DV. Practice styles and preferences of ASCRS members—1992 survey . J Cataract Refract Surg . 1993;19:600-606.Crossref 3. Steinberg EP, Bass EB, Luthra R, et al, for the Cataract Patient Outcome Research Team. Variation in ophthalmic testing prior to cataract surgery: results of a national survey of ophthalmologists . Arch Ophthalmol . 1994;112:896-902. 902.Crossref 4. Hollander M, Wolfe D. Nonparametric Statistical Methods . New York, NY: John Wiley & Sons Inc; 1973. 5. Schein OD, Steinberg EP, Javitt JC, et al. Variation in cataract surgery practice and clinical outcomes . Ophthalmology . 1994;101:1142-1152.Crossref 6. Hodgkins PR, Luff AJ, Morrell AJ, Teye Botchway L, Featherston TJ, Fielder AR. Current practice of cataract extraction and anaesthesia . Br J Ophthalmol . 1992;76:324-326. 7. Courtney P. The national cataract surgery survey, I: method and descriptive features . Eye . 1992;6:487-492.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Sep 1, 1995

References

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