Teaching manual cataract extraction

Teaching of manual cataract extraction in ophthalmic surgical training programmes

BACKGROUND

Manual cataract extraction techniques such as extracapsular cataract extraction (ECCE) or manual small incision cataract (MSICS) surgery have been replaced by phacoemulsification cataract surgery. Surgical training opportunities for manual techniques of cataract extraction are limited in modern surgical training programmes.

AIMS

This study evaluated the current trends of ECCE/MSICS training opportunities amongst trainees and trainers in the Irish Ophthalmic Surgical Training Program.

METHODS

An electronic survey was distributed to all ophthalmic surgical trainees and consultants in the country. It addressed the experience and exposure to ECCE/MSICS.

RESULTS

Nineteen of 33 (57%) trainees and 29 of 55 (55%) of consultants completed the survey. Twelve of 19 (63%) trainees viewed an ECCE procedure performed live. Twenty-seven of 29 (93%) consultants performed an ECCE procedure during their surgical career; 8 of 27 (30%) performed an ECCE within the last 1-3 years. Fourteen of 19 (74%) trainees stated they do not feel confident converting from phacoemulsification to ECCE independently. Sixteen of 19 (89%) trainees believe manual cataract extraction training should be included in their surgical training. Nineteen of 29 (65%) consultants believe training in manual cataract extraction should be part of the surgical training programme.

CONCLUSIONS

There is a paucity of manual cataract extraction being performed in Ireland, limiting live surgical training in this technique. This survey highlights the limited experience of trainees in this valuable skill that is occasionally required for a successful surgical outcome. The authors conclude that wet laboratory simulated training of manual cataract extraction will bridge this gap.

Cataract Surgery Numbers in U.S. Ophthalmology Residency Programs: An ACGME Case Log Analysis

PURPOSE

To describe and assess the cataract experience of ophthalmology residents throughout the United States (U.S.).

METHODS

Cataract procedures logged by graduating ophthalmology residents nationwide and published by the Accreditation Council for Graduate Medical Education (ACGME) from 2009 to 2020 were analyzed using linear regression on log-transformed response variables with robust variance.

RESULTS

As primary surgeon, average numbers logged for phacoemulsification increased yearly by an average of 4.1% prior to 2019 and then decreased by 22.1% in 2019 for an overall average yearly increase of 2.9% (95% CI: 0.5, 5.4%, p = .03), non-phacoemulsification extracapsular extraction decreased yearly by an average of 4.6% (95% CI: -7.7, -1.5%, p = .01), other cataract/intraocular lens surgeries decreased yearly by an average of 8.4% (95% CI: -10.1, -6.6%, p < .001), anterior vitrectomies decreased yearly by an average of 12.5% (95% CI: -14.9, -10.1%, p < .001), and laser capsulotomies increased yearly by an average of 6.0% prior to 2019 and then decreased by 3.0% for an overall average yearly increase of 5.3% (95% CI: 4.5, 6.2%, p < .001). As assistant, average numbers logged in all ACGME minimum categories showed decreasing trends.

CONCLUSIONS

Over the last decade, the average numbers of phacoemulsification and laser capsulotomies logged by residents as primary surgeon increased while other ACGME cataract minimum procedures decreased. Surgical volume in 2019-20 was lower due to the coronavirus disease-19 pandemic but higher than from 2009 to 2013.