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September 1995

Cataract Surgical Techniques: Preferences and Underlying Beliefs

Author Affiliations

From the Dana Center for Preventive Ophthalmology, The Wilmer Eye Institute, Department of Ophthalmology (Drs Schein and Tielsch), and Department of Medicine (Drs Bass and Steinberg), School of Medicine, and Department of Health Policy and Management, School of Hygiene and Public Health (Drs Bass and Steinberg), The Johns Hopkins University, Baltimore, Md; The Johns Hopkins Program for Medical Technology and Practice Assessment, The Johns Hopkins Health Institutions (Drs Bass, Luthra, and Steinberg); Department of Information Systems and Decision Sciences, Sellinger School of Business, Loyola College, Baltimore (Dr Sharkey); and Worthen Center for Eye Care Research, Department of Ophthalmology, Georgetown University Medical Center, Washington, DC (Dr Javitt). The authors have no proprietary interest in the companies or products mentioned in this article.

Arch Ophthalmol. 1995;113(9):1108-1112. doi:10.1001/archopht.1995.01100090030018

To characterize the intraoperative procedures employed by cataract surgeons in the United States and the beliefs underlying the practices, a standardized questionnaire was sent to a systematic random sample of members of the American Academy of Ophthalmology in 1992. Of 667 surveyed ophthalmologists, 550 completed the questionnaire (response rate, 82.5%). Phacoemulsification was used for more than 75% of routine cataract surgery by 46% of respondents, whereas standard extracapsular surgery was used for more than 75% of routine cataract surgery by 41% of respondents. Preferential use of phacoemulsification was independently associated with more recent graduation from medical school and higher reported annual surgical volume. Continuous tear capsulotomy was employed by 52% of ophthalmologists. Preference for this technique was independently associated with both the use of phacoemulsification and higher annual surgical volume. Seventy-one percent of respondents used retrobulbar anesthesia, whereas 28% used peribulbar anesthesia. Use of peribulbar anesthesia was independently associated with both greater surgical volume and performance of surgery in an ambulatory surgical center. Beliefs regarding comparative safety and effectiveness were reported to influence surgeons' preferences strongly among all of the competing techniques studied. Those performing phacoemulsification, in comparison with those performing extracapsular cataract extraction, reported that the expectation of reduced astigmatism and shorter recovery time strongly influenced their choice of procedure. Variation in preferred intraoperative techniques is substantial for cataract surgery and the beliefs that underlie the preferences. Such variation highlights the need to determine which techniques maximize patient outcomes and are most cost-effective.