Improved Refractive Outcomes of PGY-4 Cataract Surgery after Structure and Process Changes at a Teaching Program

Abstract

 

Purpose

 

A previous ARVO abstract (#5443, 2010) showed greater variability in PGY-4 refractive outcomes at a VA teaching hospital compared to experienced surgeons. Since then structure and process changes to our program were made including: 1) Creation of a new program and competency based curriculum 2) Longer PGY-4 rotation at the VA [12 months increased from 6 months] 3) Use of immersion biometry for all IOL calculations 4) Creation of a formal lecture on biometry and keratometry, and 5) Attending commitment to closer evaluation of pre-operative IOL selection. This study’s purpose was to examine the impact of these changes.

 

Methods

 

124 un-eventful cataract surgeries performed by 4 different PGY-4 residents from Jan - Jun in years 2012/2013 (Group A) were compared to 172 cases performed by 4 residents from Jan - Jun in years 2008/2009 (Group B). Inclusion criteria and average age of the groups were the same. Actual Postoperative Refractive Error (POR) was measured. Predicted Postoperative Refractive Error (PPOR) was calculated with the Holladay I (H1), SRK II (S2), and SRK/T (ST) formulas. The Mean Absolute Difference (MAD) between POR and PPOR for the two groups were analyzed using a two tailed Student’s t test and were compared to reported results for experienced attending surgeons.

 

Results

 

In Group A, 45.2% of patients (an average of the H1, S2, ST percentages) had an MAD within 0.25 diopters, compared to 23.7% in Group B. 72.9% of Group A and 45.7% of Group B fell within 0.50D. 7.3% of group A and 25.3% of group B had MAD greater than 1.0D. 0.8% of group A and 9.1% of group B had MAD greater than 2.0D. Refer to Table 1 for individual H1, S2, and ST comparisons. Outcomes were significantly better in Group A for all categories examined (p<0.00001).

 

Conclusions

 

Predictability of POR outcomes following uneventful cataract surgery by PGY-4 residents significantly improved for Group A compared to Group B, approaching the reproducibility of experienced attendings. Non-optimized H1, S2 and ST formulas performed equally well. This data justifies the use of premium lenses in this patient population. Significant improvements in resident surgical outcomes are possible when areas for improvement are identified and addressed by changes in the process and structure used to deliver resident education.

 

 

Table 1. Comparison of Mean Absolute Difference (MAD) for H1, S2, ST formulas (in percentages)

 

Keywords: 737 training/teaching cataract surgery • 567 intraocular lens • 678 refractive surgery