Abstract
Purpose :
To report the utility of St. Thomas’ Hospital Cataract Risk Stratification Tool (Cat-12) in femtosecond laser assisted cataract surgery (FLACS) research and NHS patients undergoing conventional cataract surgery. Trainees, fellows and consultants were selected into 3 groups to keep complications within national standards for all surgeon grades.
Methods :
609 patients, 338 female (mean age 71y) and 271 male (mean age 69y) treated between November 2017-February 2018 were included. 330 underwent conventional surgery, 279 underwent FLACS. Cat-12 stratifies risk into: low (score<3), moderate (3-6), and high risk (>6). Surgeon selection was any grade for low risk; fellows/ consultants for moderate risk, consultants for high risk cases. Accurate completion of Cat-12 was examined, all complications by surgeon grade, and risk category analysed.
Results :
Cat-12 was completed in 98% of all participants. 68% were considered routine (<3 Cat-12 score). 22.5% of these were performed by trainees, due to consultants recruiting routine cases for FLACS research. For moderate risk cases, 40% were performed by trainees/fellows, 60% by consultants. Similarly, 37% high risk cases were performed by trainees/fellows (9%,28%). Our trainees and fellows were exposed to higher complexity cases, with adequate supervision based on Cat-12 stratification. PCR rates were 1.2% in low risk, 1.5% moderate risk and 2.2% in high risk groups, better than UK published standards for cataract surgery. There were more complications in the conventional surgery group (n=22) compared to FLACS (n=9), most commonly iris trauma (n=8) followed by anterior chamber tears (5 manual capsulorhexis, 3 rhexis tags following FLACS). There were no cases of endophthalmitis, one case of suprachoroidal haemorrhage in a high risk case, which was performed by a consultant, with a good final outcome.
Conclusions :
Using the Cat-12 Tool, we identified the level of supervision required, and grade of surgeon needed to deliver safe, effective surgery. Trainees and fellows performed higher complexity cases (medium and high risk, while routine cases were recruited into research). We report low complication rates when juniors were supervised by the correct level of surgeon selected at the time of listing. There was no difference in complication rates between our junior and senior surgeons.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.