NEWS & OPINION 56 EWAP SEPTEMBER 2023 prior to refractive and cataract surgery, respectively. Finally, the percentage of delegates performing glaucoma surgery, including MIGS or lasers, has decreased significantly over the study duration alongside a significant increase in the number of respondents stating they only have a medical glaucoma practice (p<0.01 for both). Discussion Analysis of annual survey trends by large ophthalmologic societies highlights the practice patterns, rate of evolution, and potential patient care and public health needs across populations. In this retrospective review of 6 years’ worth of survey data, Kohnen et al. provided perspective on the current state of cataract and refractive surgeons practicing predominantly in Europe. ESCRS members reported relatively lower cataract and corneal refractive surgical volume compared to ASCRS members but similar to those reported by the Korean Society of Cataract and Refractive Surgery (KSCRS). 2,3,4 Interestingly, both ESCRS and ASCRS members endorsed increasing use of presbyopia-correcting and toric IOLs as well as preoperative Scheimpflug tomography; however, the use of toric IOLs and tomography in ESCRS members has lagged behind that of ASCRS members, suggesting a higher threshold for or slower adoption of change among ESCRS members. 2,3 Perhaps most notably, the ESCRS survey trend demonstrates a significant decrease in members performing glaucoma surgery, including MIGS and laser procedures, with fewer than 30% of ESCRS members performing glaucoma procedures compared to 49% of ASCRS members. 2 The differences in use of MIGS may be attributable to increased availability and confidence among U.S. respondents; however, the absolute difference in glaucoma practice demonstrates that a significantly higher proportion of ESCRS members maintain a medical glaucoma only practice compared to their ASCRS counterparts. Literature on procedural glaucoma management in Europe is divided with several country- based studies suggesting that rates of glaucoma procedures have increased over the last decade whereas another study evaluating first glaucoma surgical referrals across Europe suggests that up to 50% of glaucoma surgical referrals may occur late and require earlier attention. 5,6,7 While the underlying cause of this trend is unclear, the results of this survey may reflect a developing need for surgeons comfortable with glaucoma procedures among the ESCRS community. EWAP References 1. Hoffer KJ. Survey on the use of intraocular lenses. Ophthalmology. 1978;85:400–407. 2. 2018 ASCRS Clinical Survey. EyeWorld. Available at: https:// supplements.eyeworld.org/eyeworld- supplements/december-2018-clinical- survey. Accessed May 15, 2023. 3. 2019 ASCRS Clinical Survey. EyeWorld. Available at: https:// supplements.eyeworld.org/eyeworld- supplements/ascrs-clinical-survey-2019. Accessed May 15, 2023. 4. Rho CR, et al. Cataract surgery practice in the Republic of Korea: a survey of the Korean Society of Cataract and Refractive Surgery 2020. Korean J Ophthalmol. 2021;35:272 – 279. 5. Bron AM, et al. Trends in operating room-based glaucoma procedures in France from 2005 to 2014: a nationwide study. Br J Ophthalmol. 2017;101:1500 – 1504. 6. Murphy C, et al. Recent trends in glaucoma surgery in Scotland, England and Wales. Br J Ophthalmol. 2015;99:308–312. 7. Holló G, et al. Referral for first glaucoma surgery in Europe, the ReF - GS study. Eur J Ophthalmol. 2019;29:406–416. Editors’ note: Dr. Oh is an Ophthalmology Resident at Columbia University Irving Medical Center, New York, New York. ESCRS Clinical Trends Survey 2016–2021: 6-year assessment of practice patterns among society delegates Kohnen T, et al. J Cataract Refract Surg. 2023;49:133–141 Purpose: To evaluate clinical opinions and practice patterns of delegates to the European Society of Cataract and Refractive Surgeons (ESCRS). Setting: Clinical Trends Surveys were administered during annual ESCRS congresses held from 2016 to 2021, and data was collected online and in person. Design: Survey questions addressed several specialty areas, including cataract surgery, presbyopia-correcting and toric intraocular lenses (IOLs), ocular surface disease, and glaucoma. Methods: Survey results were compared and analyzed across 6 years. Four main profile questions were used for cross-tabulation analyses of questions pertaining to refractive surgery: practice location, years in practice, primary surgery setting, and average annual volume of cataract surgery. Results: The highest number of responses (3,019) was collected in 2019, with the lowest (569) received in 2020. The use of presbyopia- correcting and toric IOLs has increased significantly from 2016 to 2021, with certain respondent segments using them more frequently than others. While optical biometry remains the preferred method for obtaining preoperative measurements, the use of tomography (Scheimpflug) has significantly increased. In 2021, 61.1% and 44.9% of respondents always performed preoperative checks of the ocular surface before refractive and cataract surgery, respectively. The proportion of respondents who perform glaucoma surgery has significantly decreased over the years, with an increasing number of delegates reporting having only a medical glaucoma practice. On average, 5.4% of patients with cataract and glaucoma underwent combined MIGS and cataract procedures in 2021. Conclusion: Evaluation of the Clinical Trends Survey data provides valuable insights into the shifting practice patterns and clinical opinions of ESCRS delegates.
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