April 2019


Presentation spotlight
Refractive and cataract surgical trends in Holland

by Stefanie Petrou Binder, MD EyeWorld Contributing Writer

“Refractive surgery is not a big thing in Holland. Our survey demonstrates that the majority of our surgeons do not have anything to do with refractive surgery.”
—Ype Henry, MD


Data reveals interesting trends in Dutch refractive surgical preferences, according to a survey conducted by Ype Henry, MD, who reported the outcomes of the 2017 survey at the 36th Congress of the European Society of Cataract and Refractive Surgeons.
Dr. Henry’s survey includes data collected from 1998 to 2016 with a 62% response rate among Dutch eyes surgeons. The analysis indicates a steady rise in cataract surgeries, numbering 185,000 operations (population 16 million) in 2017. The monthly cataract volume is also increasing, with the largest number of surgical practices now performing between 26 and 50 cataract surgeries per month, closely followed by practices performing 16 and 25 cataracts per month.

Refractive surgery

“Refractive surgery is not a big thing in Holland. Our survey demonstrates that the majority of our surgeons do not have anything to do with refractive surgery,” Dr. Henry said.
Just over 80% of Dutch surgeons do not perform refractive surgery. The survey indicates that the numbers of laser surgeries like PRK (performed by 35% of surgeons) and transPRK (performed by just under 20% of surgeons) are increasing and that LASIK is more or less stable over time (performed by roughly 20% of surgeons). Phakic IOL surgeries are relatively stable (performed by about 20% of surgeons), and refractive lens exchange is gaining in popularity (done by about 25% of surgeons), the survey showed.
“The outcomes of this survey show very low rates for cataract surgical complications like dropped nuclei, endophthalmitis, and toxic anterior segment syndrome,” Dr. Henry said.

Surgical preferences

According to the 2017 survey, more than 70% of routine cataract cases in Holland involve topical anesthesia, however, there still is a small percentage of surgeons who continue giving retrobulbar anesthesia (5%) and sub-Tenon’s anesthesia (22%).
The majority of incisions are superior (more than 90%) and between 40% and 60% are corneoscleral, while 30% are straight corneal. Coaxial phacoemulsification is the preferred method (close to 80%) and bimanual (roughly 20%), with surgeons opting mostly for the divide and conquer technique using the classic four quadrant approach, with chop, flip, and other approaches hardly used by Dutch surgeons.
In terms of standard IOL preferences, Dr. Henry explained that Dutch doctors largely prefer hydrophobic acrylic, with hydrophilic and silicone IOLs chosen less frequently, overall, among refractive surgeons.
Four percent of IOL implants involve toric IOLs in Holland. The majority of Dutch surgeons implant toric IOLs, with the surgical volume evenly distributed among those implanting 1 to 5, 5 to 10, 10 to 25, and 25 to 50 toric IOLs each month. Around 2.5% of surgeries use multifocals and 1% use multifocal torics.
Dr. Henry said, “Clearly, we do not see big numbers of torics and multifocals in our practices. We have copayment in Holland, which gives patients a basic reimbursement for cataract surgery, and the patient can ask for toric or multifocal reimbursement, but it is not always approved. But we are not used to paying extra for our health care; it is just not done in Holland.”
Almost 80% of surgeons in Holland did not experience a dropped nucleus in the survey year. A very small percent experienced two dropped nuclei. Endophthalmitis is reported in 0.02% of ophthalmic surgeries, one in 4,000. Almost 60% of Dutch surgeons use cefuroxime routinely after surgery and in 26% of high risk patients. Toxic anterior segment syndrome is seen in around 0.02% of cases, one case in 4,000 surgeries.

Postoperative visits

Dr. Henry observed noteworthy changes in the way in which Dutch patients keep appointments following cataract surgery. While nearly 100% of patients visit their surgeon within 3 to 6 weeks after cataract surgery, less than 20% present the day after surgery for their first postoperative checkup, and very few visit the doctor even within the first week of surgery. Sixty percent call by phone the day after surgery.
“The first postoperative visit is changing rapidly,” he said. “About 48% of patients do not come into the office in the days following surgery, preferring to call in instead. They remove their own bandage and clean the eye, and although I do not like it, it’s what is happening now. Less than one third come into the office as scheduled. For cataract reimbursement in the Netherlands, however, the patient needs to visit the surgical center where the operation was done or he will not be reimbursed, and that is why we have such a high number of visits between 3 and 6 weeks after surgery,” he said.
The Netherlands uses a national database system that includes thorough information from about 60% of cataract cases. Overall, up to 98% of Dutch doctors use the electronic database to enter information on cataract outcomes, according to Dr. Henry.

About the doctor
Ype Henry, MD

VU Medisch Centrum
Amsterdam, the Netherlands

Financial interests
: None

Contact information
: oogheelk@vumc.nl

Refractive and cataract surgical trends in Holland Refractive and cataract surgical trends in Holland
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