Abstract
Purpose :
To evaluate visual acuity (VA) outcome and complications, and risk factors for VA outcome from the resident-performed cataract surgery at a diverse Veterans Affairs hospital system population.
Methods :
A retrospective chart review was conducted for patients who underwent cataract surgery by residents at the Philadelphia Veterans Administration Medical Center from 01/01/2013 – 12/31/2015. Clinical information including preoperative, intraoperative, and postoperative visual acuity (1 day, month 1, 2-3 and 6) and surgery complications was collected. Descriptive analyses were performed for complication rate, and univariable and multivariable linear regression models were performed for risk factors of VA change from baseline at 1 month and VA change from baseline at all post-operative visits combined.
Results :
This study included 1183 patients, with mean (SD) age of 70.8 (9.3) years, 41.7% were African American, 57.6% were Caucasian, and 97.5% were male. The mean (SD) VA in logMAR was 0.69 (0.74) at baseline, and improved to 0.19 (0.36) at 1 month, 0.16 (0.34) at 2-3 months and 0.14 (0.36) at 6 months (Table 1), with 91.3% patients having VA improvement from baseline at 1 month, and 86.5% patients achieved 20/40 or better at 1 month. Analysis by baseline visual acuity levels demonstrated that individuals with baseline visual acuity of worse than 20/40 experienced significant improvement from baseline (Table 1). Complications from cataract surgery were minimal, including hyphema (0.3%), dropped nucleus (1.8%), iris prolapse (0.8%), anterior capsular tears (0.6%), posterior capsular tears (4.0%), zonular dehiscence (1.1%), and vitreous loss (5.4%). In multivariate analysis, younger age (p<.0001), worse baseline visual acuity (p<.0001) and absence of iris prolapse (p<.001) were significantly associated with greater improvement in VA at 1 month.(Table 2)
Conclusions :
Resident-performed cataract surgeries achieve significant improvement in visual acuity with a complication rate lower than previously reported in residents, and not substantially greater than in the cataract literature. There is a clear benefit from resident-performed surgery as a means of providing surgery with successful outcomes in this specific population of patients.
This is a 2021 ARVO Annual Meeting abstract.