April 2008




Comparing surgery results

by Matt Young EyeWorld Contributing Editor


Article describes in depth one Web-based system to manage patient data

New technology is forthcoming that will make it easier for ophthalmologists to compare refractive surgery results. Research published in the online version of Computer Methods and Programs in Biomedicine in October 2007, described a Web-based information system to manage and analyze patient data after refractive surgery. The software the article describes (called IBRA, or Internet-based refractive analysis, Zubisoft GmbH, Leeds, United Kingdom) isn’t the only one available now to perform such analysis, but the fact that the technology is being made available widely indicates a growing trend for performing such analysis. Currently, literature searches are common to compare surgical results. But comparisons of the future could be more relevant if they are based on more timely information, which conceivably this technology could help to do. At least one ophthalmologist has noted that current risk factors for ectasia are based in part on older refractive cases, when less was known about the condition. Comparisons of more current ectasia cases—through Web-based interaction—could eventually help to establish risk factors based on the most current cases.


IBRA provides standard analysis, vector analysis, and nomogram calculations. Although other software is available that performs these functions, they do so separately, and make double-data entry a hassle. The greatest advantage of IBRA is the fact that it connects to the Internet. “IBRA was developed because existing commercially available software operates solely on a single computer or an network in one hospital only,” wrote lead study author Bruno Zuberbuhler, M.D., St. James’s University Hospital, U.K. “More sophisticated data analysis demands a more unified automated approach between departments.” All the data was recorded on the same IBRA system, thus facilitating comparisons no matter where you are in the world. “Using IBRA, comparisons between the laser center in Leeds, U.K., and the laser clinic in Lucerne, Switzerland, were possible,” Dr. Zuberbuhler wrote. “Multicenter functions facilitated comparisons between different surgeons and laser units.”

Users could create, change, or cancel comparative associations with other surgeons or centers themselves. It is not possible to identify any treated patient using the software, as a protection for surgeons. “The data from partners appeared only in-group analyses,” Dr. Zuberbuhler wrote. “At no time was it possible to select or analyse single patient data or to identify any treated patient by using the multicenter function.” IBRA did not permit much flexibility with follow-up data entry, however. “One of the disadvantages of IBRA was the fixed data structure with predefined data fields for the follow-up at seven days, one, three, six, 12, and 24 months,” Dr. Zuberbuhler wrote. “IBRA did not permit any change in the data entry fields; for example, the addition of a two-month follow-up period was not permitted. This limitation was imposed to maintain data collection intervals within the time frames accepted as standard in peer-reviewed literature.”

Worried about a server that’s down? Or unsecured data floating around in cyberspace? You shouldn’t be, Dr. Zuberbuhler noted. “The used technology proved to be fast and reliable,” he wrote. “During the 12 months of running the database, in only 2.4 hours it was not possible to connect to the database; 1.5 hours of this time-out related to an update on the server itself. IBRA was easy-to-use by a common Internet browser with no additional software downloads, allowing secure and immediate access to the application from different locations.” But William Trattler, M.D., director, Cornea, Center for Excellence in Eye Care, Miami, noted that IBRA is not the only Internet tool available to compare refractive results. “VISX’s [AMO, Advanced Medical Optics, Santa Ana, Calif.] [comparative] system just went online,” Dr. Trattler said. “We’re hopefully going to start using it very soon.” Other online systems allow comparisons between ReSTOR (Alcon, Fort Worth, Texas), ReZoom (AMO) and other presbyopic lenses, he said. “It’s a lot of work,” Dr. Trattler said. “That’s the hard part since it takes man hours to enter all the data. It’s good, but a challenge.”

The key, therefore, is to have someone employed willing to enter the data. “If you have two cases a week, it’s no problem,” Dr. Trattler said. “It probably takes 10 to 15 minutes per chart.”

In the future, it would be optimal if refractive data could somehow be entered automatically, such as an automatic transmission from the laser to the database, he said. Additionally, he said: “Let’s say you have a bad case. Are you going to enter that data?” Even if the patient is anonymous, the surgery center may not look good to others prying into a data set with some negative results.

But compared to scientific literature, more real-time results analysis is the way of the future. “The literature is always going to be a little behind,” he said.

Editors’ note: Dr. Zuberbuhler has financial interests with Zubisoft (Leeds, United Kingdom). Dr. Trattler has no financial interests related to his comments.

Contact Information

Trattler: 305-598-2020, wtrattler@earthlink.net

Zuberbuhler: b.zuberbuehler@zubisoft.ch

Comparing surgery results Comparing surgery results
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