EyeWorld India September 2016 Issue

September 2016 EWAP FEATURE 29 Controversies in ophthalmology – survey results from the U.S. and the Asia-Pacific by EyeWorld Staff S urgeons have varying protocols for cataract and refractive procedures. In the 2015 ASCRS Clinical Survey, ASCRS members were surveyed about their surgical practices. Data was also collected from surgeons in the Asia-Pacific region during the last APACRS annual meeting. Here are some of the results regarding the more controversial issues in ophthalmology. Ophthalmologists were asked about their antibiotic use before, during, and after cataract surgery. The ASCRS Clinical Survey found no consensus majority protocol, and antibiotics were used preoperatively (either 1 day or 3 days preop) by one-third of respondents. “Europeans have led the way in studying the use of intracameral antibiotics,” said John Berdahl, MD , Sioux Falls, South Dakota. “American surgeons are using them more and more, but I think non- U.S. surgeons, and particularly Europeans, will continue to lead the way as they have the most experience and have generated the most data. Additionally, there is a financial disincentive in the U.S. to use intracameral antibiotics (even though it saves patients and the system money) because they are currently not reimbursed in the surgical setting.” Surgeons were asked how often they perform simultaneous bilateral cataract surgery in both the ASCRS and APACRS surveys. While the majority of U.S. surgeons in the ASCRS survey said they do not perform simultaneous bilateral cataract surgery, only 11% of surgeons from the Asia-Pacific said that they do not perform the procedure, with 59% saying they perform it for extenuating circumstances—the latter being the most common reason for performing the procedure, followed by patient convenience (Figure 1). According to Boris Malyugin, MD , Moscow, there are several reasons explaining the modest popularity of simultaneous bilateral cataract surgery today. “There are patient-related reasons. Often, when a patient with a cataract is admitted to the eye clinic, his or her vision in one eye is worse than in the other, and it is hard to convince the patient [to have] two surgeries at the same time rather than doing that in a sequential manner,” he explained. He noted that there are also surgeon-related factors. “Many surgeons think that if any kind of devastating event happens during or after the surgical procedure (i.e., intraocular hemorrhage, infection, etc.), it is better to ‘preserve’ the second eye and keep it intact,” he added. There are economic reasons because “in many health systems, the simultaneous second eye surgery is either not reimbursed at all or reimbursed at a fraction of the price of the first surgery. So in many cases, it is economically unreasonable to perform two surgeries at one time,” he explained. Additionally, he noted that several published studies show the benefit of adjusting the IOL power in the second eye based on the refractive results of the first eye surgery. Regarding laser vision correction, surgeons were asked, “What category of ablations are the majority of your corneal refractive procedures, currently and in the next 2 to 3 years?” Fifty-two percent (52%) of surgeons in the Asia-Pacific region said that they currently use wavefront ablations, with 33% using optimized and 19% using customized (Figure 2). In comparison, according to the ASCRS survey data, a higher percentage of U.S. surgeons (81%) said that they currently Figure 2. Surgeons were asked, “What category of ablations are the majority of your corneal refractive procedures currently?” Source: ASCRS/APACRS Figure 1. Surgeons who perform simultaneous bilateral cataract surgery were asked their primary reason for doing so. use wavefront ablations, but with more using customized (52%) than optimized (29%). Seventy-nine percent of U.S. surgeons in the ASCRS survey said that they plan to use wavefront in the next 2 to 3 years (44% customized and 34% optimized). For non-U.S. surgeons in the ASCRS survey, the percentage who will use topography-customized ablations increases to 18%, and the percentage who will use femtosecond intrastromal lenticule extraction increases to 16%. Surgeons were also asked, “What percentage of your current corneal refractive procedures involves femtosecond intrastromal lenticule extraction?” Eighty-three percent of surgeons in the ASCRS survey said that none of their current corneal refractive procedures involves femtosecond intrastromal lenticule extraction (90% of U.S. surgeons and 76% of non-U.S. surgeons), while 13% said that 10% or more of their procedures involves femtosecond intrastromal lenticule extraction. EWAP Editors’ note: Dr. Berdahl and Dr. Malyugin have no financial interests related to their comments. Contact information Berdahl : john.berdahl@vancethompsonvision.com Malyugin : boris.malyugin@gmail.com