Defining the surgical footprint in cataract surgery: patient-related outcomes dependent on the experience of the surgeon

Abstract

Purpose: To investigate which patient-related outcomes are dependent on the experience of the cataract surgeon. Methods: The study was designed as a prospective observational study. Novice (<150 surgeries performed) and experienced (>1000 surgeries performed) cataract surgeons from the Department of Ophthalmology, Rigshospitalet – Glostrup and Nordsjællands Hospital – Hillerød were included in the study. Patients operated by the included surgeons were examined preoperatively, 1 day, 3 days, and 3 weeks after standard, noncomplicated cataract surgery. Primary outcomes were change in central corneal thickness and endothelial cell loss. Secondary outcomes were best-corrected visual acuity, intraocular pressure, aqueous flare, central macular thickness, and surgical complications. Results: Surgery performed by novice surgeons resulted in significantly lower visual acuity (mean −3.6 letters (Early Treatment Diabetic Retinopathy Study (ETDRS)); 95% CI: −7.3; −0.4, p = 0.03) and greater corneal thickness (mean 26.7 µm; 95% CI: 6.8; 46.6, p = 0.01) on the first day postoperative than surgery performed by experienced surgeons. Conclusion: The experience of the cataract surgeon affected visual acuity and central corneal thickness in the immediate postoperative period. In the future, these patient-related outcomes may be used to assess the technical proficiency of surgical trainees and investigate the effect of different training programs.