Trends in congenital nasolacrimal duct obstruction surgical procedures in the United States from 2003 to 2016

Longitudinal trends in volume of oculoplastic procedures without ACGME minimum requirements among United States ophthalmology residents: an ACGME case log analysis

PURPOSE

To our knowledge, there have been no previous reports that investigate trends in ophthalmology residents' exposure to oculoplastic procedures without Accreditation Council for Graduate Medical Education (ACGME) minimum requirements. To fill this knowledge gap, we investigated publicly available ACGME ophthalmology residency case logs from 2009 to 2021.

METHODS

National resident averages and standard deviations were collected for the following oculoplastic procedures without minimum ACGME requirements: eye removal and implant, lacrimal surgery, other orbital surgery (e.g. orbitotomy), tarsorrhaphy, entropion/ectropion repair, temporal artery biopsy, and other oculoplastic surgery. We also collated average yearly surgical volumes of all oculoplastic procedures, "Total Oculoplastic Surgery," which includes procedures with minimum requirements and procedures without requirements. Finally, we collected the average yearly volumes of all ophthalmic procedures. Linear regressions were used to characterize trends in resident oculoplastic surgical volume.

RESULTS

We provide evidence that the average yearly volumes of all but one oculoplastic procedure without ACGME minimum requirements have been decreasing. The decreases in volume for these procedures are driven by residents having fewer cases both as primary surgeon and as assistant. In addition, while the total number of ophthalmic procedures logged by residents on average increased (β = 7.519, p = 0.0163), the average volume of total oculoplastic procedures did not demonstrate any statistically significant trends.

CONCLUSIONS

Volumes of oculoplastic procedures without ACGME minimum requirements between 2009 and 2021 have been decreasing among ophthalmology residents.

Factors Associated With Nasolacrimal Duct Probing Failure Among Children in the Intelligent Research in Sight Registry

Importance

Understanding the factors associated with nasolacrimal duct probing failure in young children may help inform practice patterns.

Objective

To identify factors associated with repeated nasolacrimal duct probing in young children.

Design, Setting, and Participants

This retrospective cohort study analyzed data from the Intelligent Research in Sight (IRIS) Registry for all children who underwent nasolacrimal duct probing before 4 years of age between January 1, 2013, and December 31, 2020.

Main Outcomes and Measures

The Kaplan-Meier estimator was used to assess the cumulative incidence of a repeated procedure within 2 years of the initial procedure. Hazard ratios (HRs) derived from multivariable Cox proportional hazards regression models were used to evaluate the association between repeated probing and patient age, sex, race and ethnicity, geographic region, operative side, laterality of obstruction, type of initial procedure, and surgeon volume.

Results

This study included 19 357 children (9823 [50.7%] male; mean [SD] age, 1.40 [0.74] years) undergoing nasolacrimal duct probing. The cumulative incidence of repeated nasolacrimal duct probing was 7.2% (95% CI, 6.8%-7.5%) within 2 years of the initial procedure. Among 1333 repeated procedures, the second procedure involved silicone intubation in 669 (50.2%) and balloon catheter dilation in 256 (19.2%). Among 12 008 children aged 1 year or younger, office-based simple probing was associated with a slightly higher probability of reoperation compared with facility-based simple probing (9.5% [95% CI, 8.2%-10.8%] vs 7.1% [95% CI, 6.5%-7.7%]; P < .001). In the multivariable model, a greater risk of repeated probing was associated with bilateral obstruction (HR, 1.48; 95% CI, 1.32-1.65; P < .001) and office-based simple probing (HR, 1.33; 95% CI, 1.13-1.55; P < .001), and a lower risk was associated with primary balloon catheter dilation (HR, 0.69; 95% CI, 0.56-0.85; P < .001) and procedures performed by high-volume surgeons (HR, 0.84; 95% CI, 0.73-0.97; P = .02). Age, sex, race and ethnicity, geographic region, and operative side were not associated with reoperation risk in the multivariable model.

Conclusions and Relevance

In this cohort study, most children in the IRIS Registry undergoing nasolacrimal duct probing before 4 years of age did not require any additional intervention. Factors associated with lower risk of reoperation include surgeon experience, probing performed under anesthesia, and primary balloon catheter dilation.