Optimization of cataract surgery follow-up: A standard set of questions can predict unexpected management changes at postoperative week one

Abstract

PurposeThere is limited evidence to inform the optimal follow-up schedule after cataract surgery. This study aims to determine whether a standardized question set can predict unexpected management changes (UMCs) at the postoperative week one (POW1) timepoint.SettingMassachusetts Eye and Ear, Harvard Medical School.DesignProspective cohort study.MethodsTwo-hundred-and-fifty-four consecutive phacoemulsification cases having attended an examination between postoperative days 5–14. A set of 7 ‘Yes’ or ‘No’ questions were administered to all participants by a technician at the POW1 visit. Patient answers along with perioperative patient information were recorded and analyzed. Outcomes were the incidence of UMCs at POW1.ResultsThe incidence of UMCs was zero in uneventful cataract cases with unremarkable history and normal postoperative day one exam if no positive answers were given with the question set demonstrating 100% sensitivity (p<0.0001). A test version with 5 questions was equally sensitive in detecting UMCs at POW1 after cataract surgery.ConclusionIn routine cataract cases with no positive answers to the current set of clinical questions, a POW1 visit is unlikely to result in a management change. This result offers the opportunity for eye care providers to risk-stratify patients who have had cataract surgery and individualize follow-up.

Can a Set of Questions after Routine Cataract Surgery Predict Unexpected Findings and Avoid an Unnecessary Follow-Up Visit?

“…The prospective cohort study included routine cataract surgery cases performed by two experienced surgeons between November 2019 and December 2020 and was based on a study by Moustafa et al [3]. The study was temporarily stopped in March 2020 due to the COVID-19 pandemic related lockdown and resumed in October 2020.…”

“…Cataracts are the leading cause of blindness affecting about 20 million people and remain an important socioeconomic and public health care problem worldwide with surgery as the only effective treatment, and the standard procedure being phacoemulsification with intraocular lens implantation [1][2][3][4][5][6][7][8][9][10][11].…”

“…Therefore, the time and number of close postoperative follow-up visits could be adjusted to detect and manage early clinically relevant complications. Such a model can reduce clinical cost, distribute physician time, and improve well-being of the patient assuring recovery after surgery as well as enhance patient satisfaction as well [3][4][5][6][7][8].…”

“…The postoperative day one examination is necessary to assess urgent postoperative complications after cataract surgery, while the postoperative month 1 examination is necessary to evaluate postoperative refraction. Nevertheless, postoperative week one review is questionable because of a low rate of unexpected complications [3][4][5][6][7][8]11,13].…”

“…There are a few studies about the usage of questionnaires after cataract surgery that could help to detect unexpected complications after cataract surgery [3,10]. In our study, we analyse whether a set of questions after a routine cataract surgery can predict unexpected findings and spare an unnecessary follow-up visit.…”