Eyeworld

86 | EYEWORLD | APRIL 2019 R EFRACTIVE PRESENTATION SPOTLIGHT by Stefanie Petrou Binder, MD EyeWorld Contributing Writer Contact information Henry: oogheelk@vumc.nl The majority of incisions are superior (more than 90%) and between 40% and 60% are cor- neoscleral, while 30% are straight corneal. Coaxial phacoemulsification is the preferred method (close to 80%) and bimanual (roughly 20%), with surgeons opting mostly for the divide and con- quer technique using the classic four quadrant approach, with chop, flip, and other approaches hardly used by Dutch surgeons. In terms of standard IOL preferences, Dr. Henry explained that Dutch doctors largely prefer hydrophobic acrylic, with hydrophilic and sili- cone IOLs chosen less frequently, overall, among refractive surgeons. Four percent of IOL implants involve toric IOLs in Holland. The majority of Dutch surgeons implant toric IOLs, with the surgical volume evenly distributed among those implant- ing 1 to 5, 5 to 10, 10 to 25, and 25 to 50 toric IOLs each month. Around 2.5% of surgeries use multifocals and 1% use multifocal torics. Dr. Henry said, "Clearly, we do not see big numbers of torics and multifocals in our practic- es. We have copayment in Holland, which gives patients a basic reimbursement for cataract sur- gery, and the patient can ask for toric or multifo- cal reimbursement, but it is not always approved. But we are not used to paying extra for our health care; it is just not done in Holland." Almost 80% of surgeons in Holland did not experience a dropped nucleus in the survey year. A very small percent experienced two dropped D ata reveals interesting trends in Dutch refractive surgical preferences, ac- cording to a survey conducted by Ype Henry, MD, who reported the out- comes of the 2017 survey at the 36th Congress of the European Society of Cataract and Refractive Surgeons. Dr. Henry's survey includes data collected from 1998 to 2016 with a 62% response rate among Dutch eyes surgeons. The analysis indi- cates a steady rise in cataract surgeries, numbering 185,000 operations (population 16 million) in 2017. The monthly cataract volume is also in- creasing, with the largest number of surgical prac- tices now performing between 26 and 50 cataract surgeries per month, closely followed by practices performing 16 and 25 cataracts per month. Refractive surgery "Refractive surgery is not a big thing in Holland. Our survey demonstrates that the majority of our surgeons do not have anything to do with refrac- tive surgery," Dr. Henry said. Just over 80% of Dutch surgeons do not perform refractive surgery. The survey indicates that the numbers of laser surgeries like PRK (performed by 35% of surgeons) and transPRK (performed by just under 20% of surgeons) are increasing and that LASIK is more or less stable over time (performed by roughly 20% of sur- geons). Phakic IOL surgeries are relatively stable (performed by about 20% of surgeons), and refractive lens exchange is gaining in popularity (done by about 25% of surgeons), the survey showed. "The outcomes of this survey show very low rates for cataract surgical complications like dropped nuclei, endophthalmitis, and toxic anteri- or segment syndrome," Dr. Henry said. Surgical preferences According to the 2017 survey, more than 70% of routine cataract cases in Holland involve topical anesthesia, however, there still is a small percent- age of surgeons who continue giving retrobul- bar anesthesia (5%) and sub-Tenon's anesthesia (22%). Refractive and cataract surgical trends in Holland About the doctor Ype Henry, MD VU Medisch Centrum Amsterdam, the Netherlands Financial interests Henry: None continued on page 88 "Refractive surgery is not a big thing in Holland. Our survey demonstrates that the majority of our surgeons do not have anything to do with refractive surgery." —Ype Henry, MD

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