August 2019

CATARACT

Best of ASCRS 2019: Cataract


by Liz Hillman EyeWorld Senior Staff Writer


Dr. Tipperman presents his selections for the Best of ASCRS 2019 Cataract papers.
Source: ASCRS

 

The Best of ASCRS 2019 is a general session at the ASCRS ASOA Annual Meeting where members of the EyeWorld Editorial Board select what they think were the best papers in different categories from the meeting. They choose from the papers that were awarded Best Paper of Session in each individual paper session throughout the meeting and explain why they made their selections.
Here we recap what those papers were in the Cataract category and why Richard Tipperman, MD, a member of the EyeWorld Cataract Editorial Board, thought they were noteworthy.

“Characteristics of cataract surgery patients influencing Press Ganey patient satisfaction scores”

Michele Lee, MD, Stephanie Chen, MD, Tiffany Chen, Ann Caroline Fisher, Charles Lin, MD, Kuldev Singh, MD, Robert Chang, MD

Dr. Tipperman said he chose this paper because it covers a topic that’s gaining more importance in the field.
“Ophthalmology does a great job of evaluating metrics in terms of patient outcomes, but insurers and payers are going to start rating us more and more, and some of those ratings end up online,” Dr. Tipperman said, explaining that this paper looks at factors that affect how people rate doctors on validated scales.
After clinic visits in Lee et al.’s cross-sectional study, patients were asked to answer questions from the Press Ganey Hospital Consumer Assessment of Healthcare Providers and Systems tool and the National Eye Institute Visual Function Questionnaire 25. One hundred and forty-three patients were included in the study, and the main outcome was the proportion of scores less than 5 (5 being “very good”) and the patient’s likelihood of recommending the practice to others. As Dr. Tipperman put it, a rating of less than 5 is considered a negative rating by many standards. The investigators looked at patient demographics, patient subjective outcomes, clinical outcomes, trainee involvement, wait times, and time with the provider.
In general, women and patients who self-reported as Asian or Pacific Islander were correlated with being more likely to provide a non-5 score. Having subjective eye pain of mild to severe was also correlated with scores less than 5. The researchers concluded that there are no conclusive studies demonstrating the relationship between patient satisfaction and clinical outcomes and lower Press Ganey scores were often related to factors outside the practitioner’s and clinic staff’s control.

“Are perioperative NSAIDs really necessary in preventing cystoid macular edema if IOP is adjusted immediately after MICS or FLACS?”

John Jarstad, MD, Van Nguyen, MD, Carli Wittgrove

Dr. Tipperman said this paper provides information that attendees can use immediately in practice.
While the main purpose of the study was to evaluate whether NSAIDs prevented CME if IOP was adjusted immediately after cataract surgery, Dr. Tipperman focused on a different facet of the study. The researchers evaluated the accuracy of manual palpation on the eye in predicting and adjusting for the correct IOP at the end of cataract surgery. The researchers found that an experienced surgeon going by feel alone, thinking IOP was normal, had IOPs that ranged from 9–67 mm Hg. Thirty-three percent of patients who did not have IOP adjusted in the OR required adjustment postop day 1, compared to less than 5% of those who did have an immediate adjustment after surgery. Eyes with immediate postop adjustments were four times less likely to develop CME.
Dr. Tipperman also highlighted additional results from the study: (1) estimated $44,000/year/doctor in savings with immediate IOP adjustment in the OR; and (2) reduced likelihood of needing postop day 1 pressure adjustment if adjusted immediately after surgery.

“Evaluating rates of cystoid macular
edema after dropless cataract surgery”

Paras Shah, MD, Mira Shiloach, MS, Marian Macsai, MD

Dr. Tipperman noted the continued theme of different methods of drug delivery seen at the annual meeting, leading him to select this paper.
Shah et al. conducted a retrospective analysis of cataract surgeries from a single surgeon. Cases were grouped by those who received conventional drops (group 1, topical steroids, NSAIDs, and antibiotics), those who received a “dropless” regimen of subconjunctival injections of triamcinolone acetate and intracameral and transzonular moxifloxacin (group 2), and those who received intracameral and transzonular moxifloxacin as in group 2 but were given topical steroids (group 3). Those in group 2 had the lowest rate of CME (1.8%), followed by group 1 (2.3%), and group 3 (3%).
“This is something that I think has been bouncing around in the journals … for a couple years now and there hasn’t been a consistent overall movement, but the question is what are people doing for their drop regimen and where will we be going as some of the newer agents come out for us,” Dr. Tipperman said.

Editors’ note: The session is available on demand for those who attended the 2019 ASCRS ASOA Annual Meeting.

About the doctor

Richard Tipperman, MD
Wills Eye Hospital
Philadelphia

Financial interests

Tipperman: None

Contact information

Tipperman
: rtipperman@mindspring.com

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