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Ophthalmologists vary widely in their approach to cataract
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
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.
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
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
of Ophthalmology 113, pp. 1108-1112 and 1105-1107.
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