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International variations in cataract surgery practices may be due in part to slower diffusion of new technology in Europe

Cataract surgery is widely accepted as an effective way to improve the vision of patients with cataracts. However, cataract surgery practices and related complications vary widely in North America and Europe, according to a recent study which was supported in part by the Agency for Health Care Policy and Research (HS07085). The researchers examined cataract surgery practices and related complications at sites in four countries known for high-quality health care systems: Canada, Spain, Denmark, and the United States.

The study revealed that the transition to the latest cataract surgical technique, phacoemulsification, was most comprehensive in the United States and Canada and only recently initiated in Spain. The transition from general to local anesthesia, considered to be less costly and less risky, was also less complete in Spain. Phacoemulsification was performed in two-thirds of the cataract extractions in the United States and Manitoba, Canada, in one-third in Denmark, and in 3 percent in Barcelona, Spain. More than 96 percent of extractions in North America and Denmark were performed with the patient under local anesthesia, whereas general anesthesia was used for 38 percent of extractions in Barcelona.

These variations in clinical practice may represent a general trend of slower diffusion of new medical technology in Europe compared with North America, note the researchers. In conducting the International Cataract Surgery Outcomes Study, they collected preoperative, perioperative, and postoperative clinical data on 1,344 patients undergoing their first eye cataract surgery. Patients were recruited from ophthalmic clinics in the four countries.

For details, see "Intraoperative clinical practice and risk of early complications after cataract extraction in the United States, Canada, Denmark, and Spain," by Jens Christian Norregaard, M.D., Ph.D., Peter Bernth-Petersen, M.D., Ph.D., Lorne Bellan, M.D., and others, in the January 1999 Ophthalmology 106, pp. 42-48.

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