Eyeworld

90 | EYEWORLD | APRIL 2019 R EFRACTIVE More information from the study • Total surgical events included: 108,854 •Percentage with visual acuity data: 85.6% • Percentage with postop refraction recorded: 57.8% • Number of uncomplicated surgeries achieving 6/12 or better: 85,784 • Percentage of patients achieving 6/6 CDVA: 50% • Percentage of patients achieving 6/6 UDVA: 27.4% The refractive cylinder by itself, across more than 51,000 eyes, was within ±0.5 D in 32.9% of patients and within ±1 D in 61.8% of patients. "That left 38.2% of patients with greater than 1 D refractive cylinder remaining, 19.4% with more than 1.5 D remaining, and 10% with a relatively disabling, greater than 2 D refractive cylinder, and that's just representative of practices in the U.K.," Dr. Darcy said. Change in SE outcomes over time "This is the most promising part of the analysis. Over the study's time period, when you look at the time frame in 5-year blocks, there has been a statistical improvement in refractive outcome," Dr. Darcy said. "If we look at ±1 in 5-year blocks, 2003–2007, 2008–2012, and 2013–2017, the percentage of eyes that were within 1 D of their planned refraction was 85.8% at the start to 92.7% by 2017. Then if we look at eyes achieving ±0.5 D, the same trend is seen, with an improve- ment from 55.3% of patients being ±0.5 to 68.8% of patients ±0.5. And there is a significant number of eyes in this dataset." While the current report gives an encouraging picture of the improvements in service delivery and in predictive postoperative refractive out- comes from the past 15 years, there are, nonethe- less, areas that merit some concern. "To date, we think this is the largest reported series of refrac- tive outcomes from cataract surgery in the United Kingdom. But the study has highlighted areas that need improvement as well," Dr. Darcy said. "Only 85% of patients had their postoperative visu- al acuity recorded and only 57% of these were refracted. There are many potential explanations for this. Looking back through the reasons we found for the incomplete datasets were patients not attending routine follow-ups and the reliance on other hospitals and external optometrists to collect data, the requirement to physically post data or send it with the patient, or the entrance of collected data into the hospital electronic record, for instance, but much of this has now been changed and improved. "What we can say, as seen in this dataset over the study period, is that our data recording has improved over the last 15 years, and in particular over the last 5 years, thanks to the digitalization of all of our data recording," he said. Despite limitations pertaining to the disad- vantages associated with retrospective studies that lack randomization, incomplete refractive data, incomplete recording of toric data limiting the in- terpretation of refractive cylinder outcomes, and a multitude of IOL variations over the years, this report described positive trends in the accuracy of obtaining predicted postoperative refraction in public cataract surgery in the U.K. According to Dr. Darcy, "This report shows that perceived improvement in service delivery are in fact true and they represent real-world improvements. We suggest that the current NHS benchmarks established in 2009 that stipulate that 85% of patients should be within ±1 D and 55% of patients should be within ±0.5 D should now be increased to 90% and 65%, respectively. The last concern is about toric IOLs. There is obvi- ously public health and rationing to consider here, but in the patients in particular who have been left with greater than 2 D of refractive cylinder, there is a strong argument that we should be dealing with that as 2 D of cylinder is potentially disabling," Dr. Darcy said. continued from page 88

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