Cataract Surgery Outcomes in New South Wales, Australia

Abstract

Aim: To prospectively assess the visual acuity outcomes of phacoemulsification surgery in 2 tertiary referral hospitals over an 8-year period, and to compare the outcomes achieved by ophthalmology consultants and registrars in routine clinical practice to assess the appropriateness of patient allocation.Methods: This prospective/retrospective case series of phacoemulsification surgery recruited patients from 1 July 2000 to 30 Dec 2008. Patients underwent detailed ophthalmic examination before and after surgery.Phacoemulsification and insertion of intraocular lens was performed by consultants and senior and junior registrars, who were allocated by the treating consultant. Postoperative review was conducted 1 day, 1 week, 1 month, and 3 months after surgery.Results: Of the 1812 cases, 1596 (88.1%) were complication free. The mean postoperative visual acuity was 0.17 LogMAR (6/9 Snellen equivalent), with 1630 cases (90.0%) achieving 0.30 LogMAR (6/12) or better. Consultants, and senior and junior registrars all achieved similar postoperative visual acuities of 0.15 to 0.17 LogMAR (p = 0.5). There was a significantly different rate of vitreous loss between the 3 groups (p = 0.002), with consultants at 2.9% (9/309), senior registrars at 1.9% (15/804) and junior registrars at 5.3% (37/699).Conclusions: The visual acuity outcomes and complication rates confirm that quality care is being delivered to patients. The different complication rates between consultants and registrars reflect consultants allocating themselves more complicated cases and the training of junior registrars. The similar postoperative visual acuities achieved showed that allocation of patients among consultants and registrars was appropriate and good visual acuity outcomes were delivered to all patients.