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R. Stacy, N. Brar, F. A. Mir, B. A. Henderson, S. L. Cremers; Refractive Outcomes in Cataract Surgeries Performed by Residents are Similar to Outcomes Achieved by Attendings. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5441.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate outcomes of cataract surgeries, including postoperative best corrected visual acuities (BCVAs) and the mean differences between target and end refractions, performed by surgeons in training and experienced surgeons at a teaching hospital.
We performed a retrospective case study of 286 cataract surgeries from January 1, 2004 to December 31, 2004 at the Massachusetts Eye and Ear Infirmary. Postoperative BCVAs and refractions (as measured by technicians) were recorded within the first 2 months after surgery for cases performed by residents without any attending assistance and cases performed by attendings alone. 27 charts were excluded from the study due to lack of postoperative refraction. Statistical analysis was performed by student t-test and Z-test.
Of the 286 cases reviewed, 176 cataract surgeries were performed by one of 11 residents under the supervision of an attending physician, and 110 cases were performed by one of 2 attending physicians. For resident cases, 52.3% (92/176) achieved a postoperative BCVA of 20/20, compared to 52.7% (58/110) of attending cases. This difference was not statistically significant (Z test, P=0.956). 88.1% (155/176) of resident cases achieved a BCVA of 20/40 or better, which was lower but not significantly different from the 95.5% (105/110) of attending cases achieving better than a 20/40 BCVA (Z test, P=0.056). Resident postoperative refractive error was within +0.50D of target refraction in 55.7% (98/176) of resident cases, within +1.0D in 83% (146/176), and within +2.0D in 96.6% (170/176). Attending case postoperative refractive error was within +0.50D in 46.4% (51/110), within +1.0D in 70.9% (78/110), and within +2.0D in 96.4% (106/110) of cases. The difference between resident and attending refractive correction was significant at 1.0D (P= 0.15, 0.02, and 0.94 for 0.5D, 1.0D, and 2.0D, respectively). The median differences in refractive errors between target and post-op values for resident and attending cases were 0.75D for residents and 0.805D for attendings. This difference was statistically significant (Mann-Whitney rank sum test, P=.009).
Cataract surgeries performed by residents do not result in significantly lower BCVAs. Furthermore, postoperative refraction is closer to target refraction in resident performed cases. Physicians at teaching hospitals can thus reassure patients who may be anxious about cataract procedures performed by surgeons in training.
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