Resident-performed immediate sequential bilateral cataract surgery during the COVID-19 pandemic

Abstract

Purpose: To assess visual outcomes and patient satisfaction for senior resident-performed immediate sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) during the COVID-19 pandemic, when minimizing healthcare-related exposures for patients and providers are paramount. Methods: This was a pilot retrospective cohort study of all ISBCS and DSBCS patients who underwent senior resident-performed cataract surgery from May to September 2020 at a single academic institution. Outcome measures were final corrected distance visual acuity (CDVA), final manifest refraction (MRx), intraoperative and postoperative complications rates, total number of visits, and patient satisfaction assessed postoperatively by telephone questionnaire. Results: Twenty-two eyes of 14 patients and 56 eyes of 28 patients underwent senior resident-performed ISBCS and DSBCS, respectively. Final CDVA was 20/25 or better in 21 (95%) ISBCS and 51 (91%) DSBCS eyes ( P = 0.670). Deviation of final MRx from target refraction was within 0.50 D in 17 (77%) ISBCS and 47 (84%) DSBCS eyes ( P = 0.522). There was no significant difference in intraoperative ( P = 1.000) or postoperative ( P = 1.000) complications. ISBCS patients averaged 3.5 fewer visits than DSBCS patients (5.9 vs 9.5, P < 0.001). All ISBCS and 20 DSBCS patients (87%) reported they were “very satisfied” or “satisfied” with their experience ( P = 0.701). Five of six senior residents responded that they preferred performing ISBCS over DSBCS. Conclusion: This early experience suggests that senior resident-performed ISBCS is as safe and effective as DSBCS, with the added benefit of averaging fewer in-person visits. Residency programs should consider offering senior resident-performed ISBCS to select patients during the COVID-19 pandemic.

Practice of immediate sequential bilateral cataract surgery (ISBCS): A teaching hospital experience in United Kingdom

“…This methodology was different from other studies using manifest refraction or bestcorrected visual acuity (BCVA) and could result in slightly worse outcomes. 2,22,23 In conclusion, our experience demonstrated successful utilisation and practice of ISBCS at a large teaching hospital cataract unit during the COVID-19 pandemic provided careful case selection was made by experienced consultant surgeons. There were reported complications, but none of which were associated with the nature of ISBCS.…”

“…Chen et al from North America also showed ophthalmology residents could be safely involved in ISBCS; surgical outcomes were comparable in resident performed ISBCS and DSBCS eyes. 23 In the UK NHS setting, a stakeholder meeting concluded that ISBCS was ethical provided patient autonomy was respected after weighing up risks and benefits of ISBCS versus DSBCS. The risk of low but potentially severe bilateral complications was possible, which needs to be understood by patients.…”

“…Chen et al from North America also showed ophthalmology residents could be safely involved in ISBCS; surgical outcomes were comparable in resident performed ISBCS and DSBCS eyes. 23…”

“…This methodology was different from other studies using manifest refraction or best-corrected visual acuity (BCVA) and could result in slightly worse outcomes. 2,22,23…”

Commentary: Immediate sequential bilateral cataract surgery during the COVID-19 pandemic

“…In a published study in the current issue of the Indian Journal of Ophthalmology ,[ 9 ] the authors assessed visual outcomes and patient satisfaction for senior resident-performed ISBCS versus DSBCS during the COVID-19 pandemic; when minimizing healthcare-related exposures for patients and providers are paramount.…”