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Medical Effectiveness/Outcomes Research

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Ophthalmologists vary widely in their approach to cataract surgery

Ophthalmologists vary widely in their choice of cataract extraction technique, type of intraocular lens (IOL) to be inserted, and type of anesthesia for cataract surgery, according to a 1991 national survey of ophthalmologists belonging to the American Academy of Ophthalmology.

The survey, supported by the Agency for Health Care Policy and Research (HS06280), showed a 50-50 split among ophthalmologists in terms of preferred surgical technique and other practice preferences. Phacoemulsification (PE) was used for more than 75 percent of routine cataract surgery by 46 percent of ophthalmologists,where as standard extracapsular cataract extraction (ECCE) was used for more than 75 percent of routine cataract surgery by 41 percent of ophthalmologists.

Conducted by Earl P. Steinberg, M.D., M.P.P., and colleagues at The Johns Hopkins University, the survey also showed that regardless of the surgical method used, ophthalmologists were convinced that their technique resulted in superior visual acuity and reduced complication rates.

These practice variations highlight the need to identify which cataract surgical techniques optimize patient outcomes and are most cost effective, notes Denis M. O'Day, M.D., in an accompanying editorial. Dr. O'Day chaired the expert panel that developed the AHCPR-supported Clinical Practice Guideline, Cataract in Adults: Management of Functional Impairment, which was released in February 1993. He points out that American ophthalmologists have been producing excellent results for many years. Patients achieve visual acuity of 20/40 or better 90 to 95 percent of the time. Thus, it is extremely unlikely that any innovation can be expected to produce significantly better results by this measure alone. Dr. Steinberg's study, according to Dr. O'Day, underscores the lack of scientific evidence for choosing one type of cataract surgery over another.

Details are in "Cataract surgical techniques: Preferences and underlying beliefs," by Oliver D. Schein, M.D., M.P.H., Eric B.Bass, M.D., Phoebe Sharkey, Ph.D., and others, and "The surgeon's dilemma," by Dr. O'Day, in the September 1995 Archives of Ophthalmology 113, pp. 1108-1112 and 1105-1107.

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