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Improving surgical outcomes.

Walia T, Yorston D - Community Eye Health (2008)

View Article: PubMed Central - HTML - PubMed

Affiliation: Ophthalmologist and Medical Director, PCEA Kikuyu Hospital, Kikuyu Eye Unit, Kikuyu, Kenya.

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Community-based studies show that up to 40% of eyes have a postoperative presenting vision of < 6/60... Eyes with intraocular lenses (IOLs) do better; however, it has been shown that even in prosperous middle-income countries, such as Venezuela, in 20% of pseudophakic eyes presenting vision was < 6/60 and in 15% best corrected vision was worse than 6/60... Poor outcomes matter... Patients deserve improved vision whenever possible and poor outcomes deter prospective patients from coming for surgery and probably reduce their willingness to pay for their treatment – particularly if they have to pay in advance! The trainees' cataract surgical skills vary greatly and it is unlikely that this change has improved cataract outcomes... Postgraduate training of eye surgeons should also have explicit targets for trainees, such as: number of operations that must be performed before trainees can qualify as ophthalmologists (e.g. in the UK, this number is 300, but most trainees perform more than 500 in practice) level of supervision: initially the trainee will be closely supervised by the trainer, but, by the conclusion of training, trainees should be able to operate on almost any cataract without supervision acceptable outcomes: e.g. simply performing the required number of operations would be insufficient if the trainee had a 25% vitreous loss rate... Prospective monitoring of outcomes was associated with an improvement in outcomes in three separate studies., Even a regular retrospective audit will identify problems and help us deal with them... If we do not set challenging outcome standards, we will remain in our ‘comfort zone’, but we are unlikely to improve our quality... Now that IOLs are almost universal and biometry is widely used, we could set standards for uncorrected vision at an earlier date — such as one week... Since most surgeons are aiming for good uncorrected vision, we should give spectacles either free of charge or for a minimal fee, to any patient who requires spectacles to achieve 6/18 or better... We have emphasised cataract surgery, as this is the most common procedure undertaken by ophthalmologists... In developing countries, it can be difficult to establish such a referral network: travel is costly and difficult for patients, and people prefer to deal with the doctor they know and trust rather than visit an unknown surgeon in a distant place... However, the outcomes of surgery for these complex conditions always improve when patients are referred to specialists who have the necessary equipment, training, and personnel to obtain the best results.

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Surgeons should routinely use preoperative biometry
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Figure 3: Surgeons should routinely use preoperative biometry


Improving surgical outcomes.

Walia T, Yorston D - Community Eye Health (2008)

Surgeons should routinely use preoperative biometry
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2643034&req=5

Figure 3: Surgeons should routinely use preoperative biometry

View Article: PubMed Central - HTML - PubMed

Affiliation: Ophthalmologist and Medical Director, PCEA Kikuyu Hospital, Kikuyu Eye Unit, Kikuyu, Kenya.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Community-based studies show that up to 40% of eyes have a postoperative presenting vision of < 6/60... Eyes with intraocular lenses (IOLs) do better; however, it has been shown that even in prosperous middle-income countries, such as Venezuela, in 20% of pseudophakic eyes presenting vision was < 6/60 and in 15% best corrected vision was worse than 6/60... Poor outcomes matter... Patients deserve improved vision whenever possible and poor outcomes deter prospective patients from coming for surgery and probably reduce their willingness to pay for their treatment – particularly if they have to pay in advance! The trainees' cataract surgical skills vary greatly and it is unlikely that this change has improved cataract outcomes... Postgraduate training of eye surgeons should also have explicit targets for trainees, such as: number of operations that must be performed before trainees can qualify as ophthalmologists (e.g. in the UK, this number is 300, but most trainees perform more than 500 in practice) level of supervision: initially the trainee will be closely supervised by the trainer, but, by the conclusion of training, trainees should be able to operate on almost any cataract without supervision acceptable outcomes: e.g. simply performing the required number of operations would be insufficient if the trainee had a 25% vitreous loss rate... Prospective monitoring of outcomes was associated with an improvement in outcomes in three separate studies., Even a regular retrospective audit will identify problems and help us deal with them... If we do not set challenging outcome standards, we will remain in our ‘comfort zone’, but we are unlikely to improve our quality... Now that IOLs are almost universal and biometry is widely used, we could set standards for uncorrected vision at an earlier date — such as one week... Since most surgeons are aiming for good uncorrected vision, we should give spectacles either free of charge or for a minimal fee, to any patient who requires spectacles to achieve 6/18 or better... We have emphasised cataract surgery, as this is the most common procedure undertaken by ophthalmologists... In developing countries, it can be difficult to establish such a referral network: travel is costly and difficult for patients, and people prefer to deal with the doctor they know and trust rather than visit an unknown surgeon in a distant place... However, the outcomes of surgery for these complex conditions always improve when patients are referred to specialists who have the necessary equipment, training, and personnel to obtain the best results.

No MeSH data available.