Purchase this article with an account.
C. S. Fong, P. Mitchell, T. de Loryn, E. Rochtchina, T. H. Hong, J. J. Wang, Cataract Surgery and Age-Related Macular Degeneration Study; Outcomes of Cataract Surgery Performed by Trainees Compared to Consultants in an Australian Cataract Surgical Cohort. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4548.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To compare surgical complication rates and outcomes (vision and quality of life improvement) for patients whose phacoemulsification surgery was performed by ophthalmic trainees with those whose surgery was performed by ophthalmic consultants.
The Cataract Surgery and Age-Related Macular Degeneration Study (CSAMD) recruited 1995 patients undergoing cataract surgery at Westmead Hospital from 2004-07. Phacoemulsification surgery with intraocular lens implantation was performed on 1830 patients. Operative details were extracted from surgical audit forms. At 24 months post-operative LogMAR visual acuity and visual function-14 (VF-14) scores were assessed.
Of the 1305 (71.3% of the 1830) patients who were reviewed 24-months after surgery, 667 (51.1%) had complete surgical audit data, including 68.5% (n=457) completed by trainees and 31.5% (n=210) by consultants. The incidence of vitrectomy and wound burns was slightly higher among the trainees (2.4% and 2.0%, respectively) than the consultants (1.9% and 0.5%, respectively). At the 24-month post-operative visit 25.6% (n=117) of patients operated on by trainees achieved VA≥6/6 and 89.9% (n=411) VA≥6/12. By comparison, 23.3% (n=49, p=0.56) of patients operated on by consultants achieved VA≥6/6 whilst 85.7% (n=180, p=0.12) had VA≥6/12. Mean VF-14 scores did not differ between those operated on by the two groups; mean score was 88.1 (95% CI 86.0-90.2) and 90.5 (95% CI 88.1-92.9) (p=0.14), respectively. Eyes operated by trainees gained 12.9 (95% CI 11.4-14.5) letters 24 months after cataract surgery relative to pre-operative visual acuity, and this was comparable to a gain of 11.6 (95% CI 9.1-14.1) letters in eyes operated by consultants, after adjusting for age, gender, pre-operative VA and diabetes status. The mean gain in VF-14 score was 0.51 (95% CI 0.40-0.61) in the trainee surgeon group compared with a 0.50 mean gain (95% CI 0.35-0.65, p=0.87 after adjusting for age and diabetes status) in the group performed by consultants.
This study provides reassuring evidence of no significant difference after 24 months in the VA outcomes and quality of life scores gained between patients having surgery by trainees or consultants in a large hospital setting.
This PDF is available to Subscribers Only