Abstract
Purpose :
To examine the association between preoperative patient risk factors, the experience of ophthalmology residents, and the complications and outcomes of cataract surgeries.
Methods :
Data from 691 consecutive cataract surgeries conducted by Ophthalmology residents at Hadassah Medical Center (1.2018-2.2022) were examined. Demographics, surgeon experience, preoperative cataract risk assessment scores, and best-corrected visual acuity (BCVA) pre- and post-operative were analyzed. The score, based on criteria established in previous studies, included: cataract density, vitrectomy, lens phacodonesis, small pupil, axial length (>30mm or <21.5mm), anterior chamber depth (<2.5 mm), patient cooperation, oral alpha-1 blocker use, diabetic retinopathy (DR) presence, Fuchs' endothelial dystrophy, and having one functioning eye. This study focused on the distribution of these risk scores among patients and how they were allocated based on the residents' surgical experience.
Results :
As residents gained experience, the proportion of surgeries performed on patients with risk factors rose from 31% (1st year) to 50% (2nd year; p<0.05) and fluctuated between 56%, 64%, and 58% (3rd, 4th, and 5th years. Simultaneously, there was a progressive decrease in the initial pre-operative BCVA (mean LogMAR, 0.54, 0.79, 0.77, 0.79, 0.79; respectively). Despite handling more complex cases over time, the rate of intraoperative complications decreased with each year of residents' experience (0.25, 0.21, 0.17, 0.25, 0.04; respectively), particularly notable in posterior capsule tears, which reduced from 12% in the 1st year to 7% in subsequent years (p=0.03), and from 11% in the 4th year to 1% in more experienced residents (p=0.01). Patients without any risk factors had a higher post-operative BCVA (mean±SD LogMAR,0.18±0.24 vs. 0.30±0.4; p<0.001) compared to those with one or more risk factors. DR Patients had more anterior capsule tears (6% vs 1%, p=0.012) and intraocular lens complications (2% vs 0%, p<0.001).
Conclusions :
Using a preoperative risk assessment score to allocate surgeries to residents at varying experience levels demonstrates a significant potential to reduce surgical complications. This approach not only ensures patient safety but also provides residents with a structured and progressive learning experience, aligning surgical challenges with their developing skills.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.