[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
September 1996

Postoperative Management of Cataract Surgery Patients by Ophthalmologists and Optometrists

Author Affiliations

From the Departments of Medicine (Drs Bass and Steinberg) and Ophthalmology (Drs Luthra, Schein, and Tielsch), The Johns Hopkins University School of Medicine, and Departments of Health Policy and Management (Drs Bass and Steinberg) and International Health (Dr Tielsch), The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md; Department of Information Systems and Decision Sciences, Sellinger School of Business, Loyola College, Baltimore (Dr Sharkey); and Worthen Center for Eye Care Research, Georgetown University Medical Center, Washington, DC (Dr Javitt).

Arch Ophthalmol. 1996;114(9):1121-1127. doi:10.1001/archopht.1996.01100140323012

Objectives:  To assess the frequency and content of postoperative operative examinations by ophthalmologists and optometrists for cataract surgery patients without operative complications and to assess the referral patterns of optometrists when complications are identified.

Design:  In 1992 we conducted a survey of randomly selected members of the American Academy of Ophthalmology and American Optometric Association. Responses were obtained from 538 (82%) of 655 eligible ophthalmologists and 130 (84%) of 154 eligible optometrists.

Results:  Eighty-eight percent of responding ophthalmologists reported that patients had 4 or more visits within 4 months after surgery, 97% of ophthalmologists performed the first postoperative examination on their cataract surgery patients, and 60% of ophthalmologists reported that no other eye professional saw their patients postoperatively. Forty-six percent of responding optometrists participated in postoperative care of cataract surgery patients, and usually performed their first postoperative examination 7 days after surgery; 78% of these optometrists reported that they saw patients 3 or more times after surgery. Postoperatively, 83% of ophthalmologists and 75% of optometrists usually performed at least 1 dilated fundus examination, 87% of ophthalmologists and 47% of optometrists performed 4 or more slit-lamp examinations, 74% of ophthalmologists and 42% of optometrists performed 4 or more tonometry tests, and 83% of both groups performed 2 or more refractions. More than 80% of responding optometrists involved in postoperative care of cataract surgery patients immediately refer a patient to an ophthalmologist if there is evidence of acute glaucoma or an unexplained decrease in vision in the eye that was operated on. For less urgent complications, most optometrists promptly make a referral to an ophthalmologist.

Conclusions:  In 1992, a small percentage of ophthalmologists and optometrists were performing fewer follow-up examinations and tests for cataract patients than recommended by the American Academy of Ophthalmology. Not all optometrists immediately refer to an ophthalmologist any acute complication that they identify postoperatively.

Cataract Management Guideline Panel. Cataract in Adults: Management of Functional Impairment . Rockville, Md: US Public Health Service; 1993. Agency for Health Care Policy and Research publication 93-0542. Clinical Practice Guideline 4.
Powe NR, Schein OD, Gieser SC, et al.  Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation . Arch Ophthalmol . 1994;112:239-252.Article
Preferred Practice Pattern: Cataract in the Otherwise Healthy Adult Eye . San Francisco, Calif: American Academy of Ophthalmology; 1989.
Steinberg EP, Bass EB, Luthra R, et al.  Variation in ophthalmic testing before cataract surgery: results of a national survey of ophthalmologists . Arch Ophthalmol . 1994;112:896-902.Article
Bass EB, Steinberg EP, Luthra R, et al.  Variation in ophthalmic testing prior to cataract surgery: results of a national survey of optometrists . Arch Ophthalmol . 1995;113:27-31.Article
SAS User's Guide: Statistics . 6.06 ed. Cary, NC: SAS Institute Inc; 1992.
Steinberg EP, Javitt JC, Sharkey PD, et al.  The content and cost of cataract surgery . Arch Ophthalmol . 1993;111:1041-1049.Article
Appropriate Care for Cataract Surgery Patients Before and After Surgery: Issues of Medical Safety and Appropriateness . Washington, DC: Office of Technology Assessment, US Congress; 1988.
Steinberg EP.  Do optometrists see what ophthalmologists see when they look you in the eye? J Clin Epidemiol . 1993;46:3-4.Article
Revicki DA, Brown RE, Adler MA.  Patient outcomes with co-managed postoperative care after cataract surgery . J Clin Epidemiol . 1993;46:5-15.Article