Eyeworld

88 | EYEWORLD | APRIL 2019 R EFRACTIVE by Stefanie Petrou Binder, MD EyeWorld Contributing Writer come into the office in the days following surgery, preferring to call in instead. They remove their own bandage and clean the eye, and although I do not like it, it's what is happening now. Less than one third come into the office as scheduled. For cataract reimbursement in the Netherlands, how- ever, the patient needs to visit the surgical center where the operation was done or he will not be reimbursed, and that is why we have such a high number of visits between 3 and 6 weeks after surgery," he said. The Netherlands uses a national database system that includes thorough information from about 60% of cataract cases. Overall, up to 98% of Dutch doctors use the electronic database to enter information on cataract outcomes, accord- ing to Dr. Henry. nuclei. Endophthalmitis is reported in 0.02% of ophthalmic surgeries, one in 4,000. Almost 60% of Dutch surgeons use cefuroxime routinely after surgery and in 26% of high risk patients. Toxic anterior segment syndrome is seen in around 0.02% of cases, one case in 4,000 surgeries. Postoperative visits Dr. Henry observed noteworthy changes in the way in which Dutch patients keep appointments following cataract surgery. While nearly 100% of patients visit their surgeon within 3 to 6 weeks af- ter cataract surgery, less than 20% present the day after surgery for their first postoperative checkup, and very few visit the doctor even within the first week of surgery. Sixty percent call by phone the day after surgery. "The first postoperative visit is changing rapidly," he said. "About 48% of patients do not Contact information Darcy: kierendarcy@me.com A new report describes encouraging trends in achieving predicted refractive outcomes in public cataract surgery in the U.K., with improvements that are having a real-world effect on patient outcomes. While the current National Health Service (NHS) benchmarks that were established in 2009 1 stipulate that 85% of patients should be within ±1.0 D and 55% should be within ±0.5 D of their predicted refrac- tive outcome, significantly improved results seen in this study suggest it may be time to revise the national targets. "We should propose that 90% are within ±1.0 D and 65% within ±0.5 D as our new guideline," said Kieren Darcy, FRCOphth, in a presentation at the 36th Congress of the European Society of Cataract and Refractive Surgeons. "There have been significant changes in the delivery of ophthalmic care over recent years, with improve- ments across the board in: biometry equipment, staff training, IOL design and models, formulae, and A-constants. But there's been a lack of direct comparative data, particularly in public healthcare Progressive improvements in NHS refractive outcomes over 15 years continued on page 90 systems in the U.K. Our record system allows us to do a longitudinal assessment of the refractive performance across healthcare services." Retrospective study of two hospital databases over 15 years The retrospective deidentified report incorporates all cataract patient outcome data from the elec- tronic surgical database of Bristol Eye Hospital and Cheltenham General Hospital between 2003 and 2017, excluding complicated surgeries and those with corrected visual outcomes below 6/12. The data was analyzed in 5-year periods and statistical analysis between the groups was per- formed. The study included 51,534 cases (60.1% of the database's total surgical events) for analysis. In terms of the spherical equivalent, a refractive accuracy of 61.9% within ±0.5 D was noted in patients across the entire study period, and 89.3% were within ±1 D. The mean absolute predictive error (MAE) was 0.498 D (SD: 0.502). continued from page 86 About the doctor Kieren Darcy, FRCOphth Head of corneal and refractive surgery Bristol Eye Hospital Bristol, U.K. Reference 1. Gale RP, et al. Benchmark standards for refractive outcomes after NHS cataract surgery. Eye (Lond). 2009;23:149–52. Financial interests Darcy: None

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