A national survey of experienced US cataract surgeons found variability in preoperative assessment, intraocular lens (IOL) selection, astigmatism management, and postoperative confidence with advanced-technology lenses, prompting an expert panel to propose a decision-making tool to support IOL-selection standardization based on objective clinical criteria and subjective patient factors. The prospective, nonrandomized survey included 134 verified responses from 127 experienced US cataract surgeons and 7 surgeons recognized for expertise with advanced-technology IOLs. Participants represented 39 states and were required to have at least 5 years of clinical practice experience and perform at least 500 cataract surgeries annually.
Following the survey, the expert cohort participated in a workshop to identify knowledge and confidence gaps and propose educational initiatives.
The survey findings, published in Expert Review of Ophthalmology, showed that optical biometry was considered essential by 87% of surgeons and all experts. Similar proportions in both groups considered topography and macular optical coherence tomography essential, but experts were much more likely to consider tomography essential (86% vs 28%).
Study author Karolinne Maia Rocha, MD, PhD, director of cornea and refractive surgery and professor of ophthalmology at the Medical University of South Carolina Storm Eye Institute in Charleston, told OM that the findings indicated variability in "IOL-selection confidence and decision-making patterns, preoperative assessment rigor, and comfort with postoperative management, highlighting opportunities for targeted education and standardization."
Experts reported a 30% lower threshold for treating astigmatism with toric IOLs than surgeons (0.71 D vs 1.01 D). All experts and 96% of surgeons used toric IOLs to treat corneal astigmatism.
Confidence in IOL selection was high overall, with 79% of US cataract surgeons reporting they were very or extremely confident compared with all experts. However, 43% of surgeons reported being very or extremely confident in managing residual refractive error and complications after advanced-technology IOL implantation, compared with all experts.
In addition, all experts reported routinely offering advanced-technology IOLs to every qualifying patient, compared with 54% of US cataract surgeons.
The expert panel proposed educational efforts focused on comprehensive preoperative assessment, IOL selection based on objective clinical criteria and subjective patient factors, postoperative management, and patient satisfaction. Its proposed decision framework incorporates ocular surface evaluation, ocular health, astigmatism, patient preferences, and lifestyle factors to guide IOL selection.
Limitations included reliance on self-reported data and surgical volumes, potential recall bias, voluntary participation bias, selection bias, and surgeon eligibility restrictions that may limit generalizability. Because the cohorts included 127 surgeons and only 7 experts, they were not intended for statistical comparison.
"Choosing the correct intraocular lens is arguably one of the most important decisions a patient with the assistance of their ophthalmologist will make for a lifetime of quality vision," said study author Eric D. Donnenfeld, MD, FACS, of OCLI Vision. "This paper provides the data and pathway for ophthalmologists to improve their selection process and clinical outcomes for their patients considering cataract surgery."