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Annika G Havnaer, Paul B Greenberg, Glenn C Cockerham, Melissa A Clark, Amy Chomsky; Cataract surgery practices in the United States Veterans Health Administration. Invest. Ophthalmol. Vis. Sci. 2017;58(8):763.
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© ARVO (1962-2015); The Authors (2016-present)
Cataract extraction is among the most frequently performed surgical procedures in the United States (US). However, few cataract surgery practice guidelines are backed by high-quality evidence, which may contribute to considerable variation in practice patterns. We surveyed chiefs of ophthalmology to create a comprehensive picture of current cataract surgery practices in the Veterans Health Administration (VHA), the largest provider of integrated health care and health professions training in the US.
An anonymous thirty-two-question survey of cataract surgery practices was formulated using an online survey program. The inclusion criterion was a chief of ophthalmology at a Veterans Affairs (VA) facility where cataract surgery was performed. An initial email containing a link to the survey was sent to participants in May 2016. Two reminder emails were sent to non-responders at one and two weeks after the initial survey was sent out; the remaining non-responders were called twice over a two-week period. The data was analyzed using descriptive statistics.
The response rate was 75% (67/89). In 39% (26/66) and 45% (29/65) of ophthalmology sections, respectively, cataract surgeons routinely ordered preoperative consultations and preoperative testing. In 33% (22/66) of sections, cataract surgeons administered intracameral antibiotics. The primary cited reasons for not using intracameral antibiotics were pharmacy or institutional difficulties (30%; 13/44), risk of dilution error (16%; 7/44), and lack of evidence (16%; 7/44). In 92% (61/66) and 30% (20/66) of sections, respectively, cataract surgeons used toric intraocular lenses (IOLs) and multifocal IOLs. In 9% (6/66) of sections, cataract surgeons performed femtosecond laser-assisted cataract surgery (FLACS). In 9% (6/66) of sections, cataract surgeons performed immediate sequential bilateral cataract surgery (ISBCS). Residents were trained in cataract surgery in 86% (57/66) of sections. Seventy-four percent (49/66) of chiefs reported a high level of satisfaction with VA ophthalmology.
In the VHA, routine preoperative testing is commonly performed and emerging practices such as FLACS and ISBCS have limited roles. The results of this survey can benchmark future trends in US cataract surgery practices, particularly in teaching hospital settings.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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