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Biomedical subjects

O D Schein

Publications and source records attributed to O D Schein.

At least 55 records · Page 3Linked to original sources
PubMed1997

International variation in anesthesia care during cataract surgery: results from the International Cataract Surgery Outcomes Study.

OBJECTIVES: To describe international variation in anesthesia care and monitoring during cataract surgery and to discuss its implications for cost and safety. METHODS: A standardized questionnaire was sent to random samples of ophthalmologists in the United States, Canada, and Barcelona, Spain, and to all ophthalmologists in Denmark. The survey was conducted in 1993 and 1994. Certified ophthalmologists who had performed 1 or more cataract extractions in the previous year were eligible for enrollment. RESULTS: The response rates were 62% in the United States (n=148), 67% in Canada (n=276), 70% in Barcelona (n=89), and 80% in Denmark (n=82). The anesthetic technique for cataract surgery varied significantly between sites (P<.001). Surgeons reported that retrobulbar blocks were used for 46% of the cataract extractions in the United States, 70% in Canada, 66% in Denmark, and 31% in Barcelona. In Barcelona, general anesthesia was used for 23% of the cataract extractions; it was used for less than 3% of the extractions at the other 3 sites. Peribulbar blocks or topical anesthesia was used for the remaining extractions. In the United States, Canada, and Barcelona, surgeons reported that vital functions were monitored during more than 97% of the extractions and anesthesia surveillance was used during more than 78% of the extractions. In Denmark, ophthalmologists reported that vital functions were monitored and anesthesia surveillance was used for 1% of the cataract extractions (P<.001). CONCLUSIONS: Substantial international variation in anesthesia care and monitoring during cataract surgery was observed. The findings suggest a need for further research to determine whether less intensive monitoring is cost-effective.

Anesthesia↗
PubMed1997

Prevalence of dry eye among the elderly.

PURPOSE: To study the demographics and estimate the prevalence of dry eye among elderly Americans. METHODS: A population-based prevalence study was performed in 2,520 residents of Salisbury, Maryland, aged 65 years and older as of September 1993. The population was derived from the Health Care Financing Administration Medicare database. After completing a standardized questionnaire pertaining to dry eye symptoms, 2,420 subjects underwent Schirmer and rose bengal tests and anatomic assessment of the meibomian glands. RESULTS: In this population, 14.6% (363/2,482) were symptomatic, defined as reporting one or more dry eye symptoms often or all the time; 2.2% (53/2,448) were symptomatic and had a low Schirmer test result (< or = 5 mm), and 2% (48/2,432) were symptomatic and had a high rose bengal test score (> or = 5). Furthermore, 3.5% (84/2,425) were symptomatic and had either a low Schirmer score or a high rose bengal score, and 0.7% (17/2,420) were symptomatic and had both a low Schirmer score and a high rose bengal score. No association of symptoms or signs was seen with age, sex, or race. Although anatomic features of meibomianitis were associated with the presence of symptoms (P = .01), 76% (67/88) of the individuals with these anatomic features were asymptomatic; 10.5% (260/2,480) reported that they currently use artificial tears or lubricants. CONCLUSIONS: Symptoms and signs of dry eye are common among the elderly but were not associated with age, race, or sex in this population-based sample of elderly Americans. Extrapolating to the United States population aged 65 to 84 years, the study yields an estimate of 4.3 million who experience symptoms of ocular irritation often or all the time.

Aged↗
PubMed1997

Results of phase III excimer laser photorefractive keratectomy for myopia. The Summit PRK Study Group.

OBJECTIVE: The purpose of the study is to determine safety and efficacy outcomes of excimer laser photorefractive keratectomy (PRK) for the treatment of mild-to-moderate myopia. DESIGN: A prospective, multicenter, phase III clinical trial. PARTICIPANTS: A total of 701 eyes of 701 patients were entered in the study; 612 eyes were examined at 2 years after surgery. INTERVENTION: Intervention was photorefractive keratectomy using the Summit ExciMed UV200LA excimer laser (Summit Technology, Inc., Waltham, MA). The treatment zone diameter used was 4.5 mm in 251 eyes (35.8%) and 5 mm in 450 eyes (64.2%). Attempted corrections ranged from 1.50 to 6.00 diopters (D). MAIN OUTCOME MEASURES: Predictability and stability of refraction, uncorrected and spectacle-corrected visual acuity, refractive and keratometric astigmatism, corneal haze, contrast sensitivity, subjective reported problems of glare and halo, and patient satisfaction were the parameters measured. RESULTS: At 2 years, 407 (66.5%) eyes achieved 20/20 or better uncorrected visual acuity and 564 (92.5%) eyes achieved 20/40 or better visual acuity. Three hundred thirty-six (54.9%) eyes were within 0.5 D and 476 (77.8%) eyes were within 1.0 D of attempted correction. Stability of refraction improved with time; 86.8% of eyes were stable within 1.0 D from 6 to 12 months, 94% were stable from 12 to 18 months, and 96.3% were stable from 18 to 24 months. There was no evidence of progressive or late myopic or hyperopic refractive shifts. One hundred fourteen (18.6%) eyes gained 2 or more lines of spectacle-corrected visual acuity, whereas 42 (6.9%) eyes lost 2 or more lines; however, of the latter, 32 (76.2%) had spectacle-corrected visual acuity of 20/25 or better and 39 (92.9%) eyes had 20/40 or better. Four hundred forty-two (72.2%) corneas were clear, 138 (22.5%) showed trace haze, 20 (3.3%) mild haze, 9 (1.5%) moderate haze, and 3 (0.5%) marked haze. On patient questionnaires, 87 (29.7%) patients reported worsening of glare from preoperative baseline; 133 (50.1%) reported worsening of halo symptoms from baseline. CONCLUSIONS: Photorefractive keratectomy appears effective for myopic corrections of -1.50 to -6.00 D. Uncorrected visual acuity is maximized in most eyes by 3 months, although some patients require between 6 months and 1 year to attain their best postoperative uncorrected visual acuity and some may require from 1 to 2 years for stabilization of refraction. Refraction stabilizes progressively without evidence of late myopic or hyperopic refractive shifts. Optical sequelae of glare and halo occur in some patients treated with a 4.5- or 5-mm treatment zone.

Adult↗
PubMed1997

Relation between signs and symptoms of dry eye in the elderly. A population-based perspective.

PURPOSE: To examine the distribution and association of dry eye symptoms, Schirmer test results, and rose bengal scores in a population-based sample of elderly Americans. DESIGN: Population-based prevalence survey. PARTICIPANTS: Involved were 2240 noninstitutionalized residents of Salisbury, Maryland, aged 65 years and older as of September 1993, and identified by the Health Care Financing Administration Medicare database. MAIN OUTCOME MEASURES: A standardized dry eye symptom questionnaire, rose bengal scoring of ocular surface staining, and Schirmer tests. RESULTS: Fourteen percent of participants reported one or more symptoms to be present often or all the time. The mean Schirmer score in the lower testing eye was 12.4 and 42% had a rose bengal score of 1 or greater. No significant differences by age, gender, or race were seen for symptoms, Schirmer, or rose bengal testing. No association was seen between lower Schirmer scores and presence of more frequent symptoms. Higher rose bengal scores were weakly associated with symptoms. The Schirmer and rose bengal test results, both individually and in combination, were insensitive in identifying individuals who had symptoms. CONCLUSIONS: Although symptoms of ocular irritation are common among the elderly, these population-based data indicate that there is minimal overlap between individuals identified by questionnaire, Schirmer tests, and rose bengal scoring.

Aged↗
PubMed1997

New objective classification system for nuclear opacification.

We have developed an autonomous objective classification scheme for degree of nuclear opacification. The algorithm was developed by using a series of color 35-mm slides acquired with a Topcon photo slit-lamp microscope and use of standard camera settings. The photographs were digitized, and first, and second-order gray-level statistics were extracted from within circular regions of the nucleus. Classifications of severity were performed by using these features as input to a neural network. Training versus classification performance was tested by using photographs of different eyes, and test/retest classification reproducibility was evaluated by using paired photographs of the same eyes. We demonstrate good performance of the classifier against subjective assessments rendered by the Wilmer grading system [Invest. Ophthalmol. Visual Sci. 29, 73 (1988)] and markedly better test/retest reproducibility.

Algorithms↗
PubMed1997

Effects of randomizing second eyes in a trial to evaluate preoperative medical testing for cataract surgery.

The statistical and practical implications of including second eye surgeries were examined in a clinical trial designed to evaluate the impact of routine preoperative testing prior to cataract surgery on major medical events occurring within seven days following surgery. In order to detect a 0.8% difference in the rates of rare major medical events between the tested and untested groups, 20,000 surgeries must be randomized. About 30% of cataract operations were estimated to be done on second eyes of patients already included in the cohort. Different options for dealing with second eye surgeries were: (1) exclusion of all second eye surgeries, (2) inclusion of second eye surgeries only if the first eye is not enrolled, (3) inclusion of first and second eyes but randomization of patients rather than eyes, and (4) inclusion of first and second eyes but randomization of surgeries rather than patients. The final decision was to exclude second eye surgeries done within 28 days of first eye surgeries, but to rerandomize all other second eye surgeries. Differences in event rates between treatment groups can be estimated using Generalized Estimating Equations, and the association between outcomes of first and second eye operations estimated with pairwise odds ratios. An anticipated small positive correlation is likely to have minimal impact on statistical power and effective sample size.

Cataract↗
PubMed1997

Function and visual impairment in a population-based study of older adults. The SEE project. Salisbury Eye Evaluation.

PURPOSE: The Salisbury Eye Evaluation (SEE) project investigates the impact of vision on functional status in a population-based sample of elderly persons. The prevalence of self-reports of functional status and the association with visual acuity loss are described. METHODS: A random sample of men and women 65 to 84 years of age from Salisbury, Maryland were recruited for home interviews and clinic examinations. Of the eligible sample, 78% responded to the home questionnaire and 65% responded to the questionnaire and the clinic examination. Binocular visual acuity of each person was measured using ETDRS charts and protocols. Questions were asked concerning activities of daily living, instrumental activities of daily living, physical function, social interaction, and activities of daily vision. Analyses of the association of presenting visual acuity worse than 20/40 with the measures of function were carried out and adjusted for age, race, and sex. RESULTS: All measures of functional status showed a decline with age; women and blacks were more likely to report difficulties. The age-adjusted proportions of those with visual impairment were not significantly different between men and women (7.2% versus 6.7%; P = 0.60). Black persons had almost twice the rate (10.4%) of white persons (5.6%; P < 0.001). Age, race, gender, and visual impairment were all significantly related to declines in functional status in multivariate models. CONCLUSIONS: Data on functional status in the project population were similar to national data and confirmed higher rates of disability in women and blacks. Binocular visual acuity worse than 20/40 appeared to have an impact on all the self-report measures of functional status. Further analyses on the interaction of vision with other comorbid conditions on function status clearly are indicated.

Activities of Daily Living↗
PubMed1997

Self-reported assessment of dry eye in a population-based setting.

PURPOSE: To report on a subjective dry eye assessment method for use in large-scale research, to evaluate its application in a population-based study of dry eye among elderly persons in the United States, and to apply novel techniques to improve simple questionnaire item summaries. METHODS: A dry eye questionnaire was administered to a population-based sample of 2520 volunteers ages 65 to 84 years in Salisbury, Maryland. Individual symptoms and signs, counts of symptoms and signs, and latent class model summary of item responses were evaluated for validity and internal consistency. RESULTS: Approximately 15% of participants reported experiencing one or more of six dry eye symptoms often or all the time; 20% reported experiencing three or more symptoms sometimes, often or all the time. Four groups were derived on the basis of symptomatology, using latent class analysis. The groups exhibited face validity, revealed symptom patterns that added specificity to simple symptom counts, and were qualitatively similar when derived separately within population subgroups. Internal consistency was moderate (Cronbach's alpha = 0.61), indicating some variability in reporting. CONCLUSIONS: Dry eye symptoms are commonly reported in a representative elderly population. Symptom data were moderately consistent, suggesting their usefulness for dry eye assessment if properly summarized. A latent class summary revealed biologically meaningful summary patterns of symptoms reported in this population and holds promise for use in risk factor investigations and in clinical trials.

Aged↗
PubMed1996

Risk factors for ocular injuries caused by air guns.

OBJECTIVE: To identify factors associated with an increased risk of ocular air gun injury among 5- to 19-year-olds. DESIGN: Case-control study. STUDY PARTICIPANTS: Cases of ocular air gun injury were identified through two ocular trauma registries. Two randomly selected control groups were identified, both through random digit dialing. Air gun-exposed controls had handled an air gun in the previous 12 months, whereas community controls had not. Parents of the cases and controls were contacted for a standardized telephone interview. The study included 124 cases, 237 air gun controls, and 159 community controls. MAIN OUTCOME MEASUREMENTS: Circumstances of the event, typical air gun use, and demographic characteristics. RESULTS: Cases were 24 times (95% confidence interval, 6.3 to 93.6) more likely to have no adult supervision at the time of air gun use than the air gun controls, almost 12 times (95% confidence interval, 3.3 to 41.1) more likely to have been at a friend's home rather than their own, and five times (95% confidence interval, 1.4 to 20.9) more likely to have been indoors at the time of air gun use. This may indicate that the air gun was handled without a specified purpose, supported by the almost six-fold (95% confidence interval, 2.2 to 14.8) increased risk of injury when the air gun was used for a purpose other than target practice. CONCLUSIONS: Unsupervised access to air guns and unstructured air gun use are the principal risk factors for ocular injury. Strategies to educate parents concerning the need to supervise such access may help to reduce this source of preventable vision loss.

Adolescent↗
PubMed1996

Postoperative management of cataract surgery patients by ophthalmologists and optometrists.

OBJECTIVES: To assess the frequency and content of post-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.

Adult↗
PubMed1996

Characteristics influencing outcomes of excimer laser photorefractive keratectomy. Summit Photorefractive Keratectomy Phase III Study Group.

PURPOSE: To identify preoperative and intraoperative characteristics associated with outcomes of photorefractive keratectomy (PRK). METHODS: In the phase III multicenter clinical trials of the Summit Technology excimer laser for corrections of 1.5 to 6.0 diopters (D) of myopia, three principal outcomes of PRK on 612 patients were examined: (1) uncorrected visual acuity of 20/40 or better, (2) predictability of refractive outcome within 1.0 D of attempted correction, and (3) stability of refractive result between 12 and 24 months. Multiple logistic regression was used to test for independent associations of multiple preoperative and intraoperative characteristics with each of these outcomes. RESULTS: Older age was independently associated with lesser likelihood of achieving 20/40 or better uncorrected visual acuity (odds ratio = 1.08 per incremental year of age, 95% confidence interval [CI] = 1.04-1.12) and with decreased predictability, specifically with overcorrection (odds ratio = 1.09, 95% CI = 1.06-1.12), but age was not associated with stability of refraction. Greater attempted correction was associated independently with a decreased likelihood of 20/40 or better uncorrected visual acuity (odds ratio = 2.78 for corrections of 3.5-5.5 D, 95% CI = 1.18-6.75; odds ratio = 4.19 for corrections of > or = 5.5 D, 95% CI = 1.66-10.58), with decreased predictability (odds ratio = 1.72 for corrections of 3.5-5.5 D, 95% CI = 1.05-2.85; odds ratio = 2.95 for corrections of > or = 5.5 D, 95% CI = 1.65-5.26), and with a reduced likelihood of stability of refraction (odds ratio = 3.46 for corrections of > or = 5.0 D, 95% CI = 1.32-9.11). No intraoperative characteristics were associated with any of the outcomes assessed. CONCLUSIONS: Using this specific excimer laser system with an optical zone of 4.5 or 5.0 mm, patient age and attempted correction are important preoperative characteristics associated with postoperative uncorrected visual acuity and predictability of PRK. Stability of refraction is strongly associated with attempted correction. Such information may help guide patient selection, determine timing of fellow eye treatment, and suggest changes in the laser treatment algorithm for individual patients. Although these findings may be representative of PRK in general, similar analyses should be performed before modifying patient treatments using either a 6.0-mm treatment zone or other laser systems.

Adult↗
PubMed1996

Risk factors for retinal detachment after cataract surgery. A population-based case-control study.

PURPOSE: Previous analyses of Medicare claims data, as well as clinical series, have suggested that performance of neodymium:YAG (Nd:YAG) laser posterior capsulotomy after extracapsular cataract surgery increases significantly the risk of retinal detachment. However, methodologic problems with previous research limit the strength of conclusions that can be drawn from these earlier studies. This study was designed to resolve those methodological limitations while using a population-based approach for assessment of the independent association between the performance of Nd:YAG laser posterior capsulotomy and pseudophakic retinal detachment. METHODS: A nested case-control study was conducted. Medicare beneficiaries who had undergone extracapsular cataract extraction from 1988 to 1990 were identified from a 5% sample of Medicare claims data. Within this cohort, people who were diagnosed or treated for retinal detachment during the years 1988 through 1991 (cases) were identified from Medicare records. Four controls were matched to each case of retinal detachment using an incidence density design. Providers of the patients' cataract and retinal surgery were contacted and asked to provide clinical data for all cases and controls that they had treated. RESULTS: Seven hundred six cases of retinal detachment were originally identified from Medicare records. After exclusions due to ineligibility, a total of 291 cases and 870 matched controls were available for analysis. Conditional logistic regression models showed that a number of factors were associated independently with an excess risk of retinal detachment after cataract surgery. These included Nd:YAG laser capsulotomy (odds ratio [OR] = 3.8; 95% confidence interval [CI], 2.4-5.9), a history of retinal detachment (OR = 2.7; 95% CI, 1.2-6.1), a history of lattice degeneration (OR = 6.6; 95% CI, 1.6-27.1), axial length (OR = 1.21/mm; 95% CI, 1.03-1.43), refractive error (OR = 0.92/diopter; 95% CI, 0.88-0.95), and a history of ocular trauma after cataract surgery (OR = 6.1; 95% CI, 4.3-28.2). CONCLUSION: Performance of Nd:YAG laser posterior capsulotomy is associated with a significantly elevated risk of retinal detachment in patients who have undergone extracapsular cataract extraction. Other independent risk factors for retinal detachment include axial length, myopia, posterior capsular rupture during surgery, history of retinal detachment or lattice degeneration, and ocular trauma after cataract surgery.

Aged↗
PubMed1995

Results of ophthalmic examinations of 29 alpacas.

Analysis of the results of ophthalmic examinations of 29 alpacas (Lama pacos) revealed a direct relationship among coat color, iris color, and ocular fundus pigmentation. Alpacas with light-pigmented coats had iris color that included combinations of gray, blue, and brown, and had reduced pigmentation of the ocular fundi. Alpacas with dark coats had brown irides and pigmented ocular fundi. Eleven alpacas had evidence of ophthalmic conditions, including bilateral conjunctivitis (1); formation of a superficial corneal scar (1); formation of posterior synechiae and anterior cataracts (4); development of a deep corneal scar with anterior synechiae, buphthalmia, a subluxated lens, and cataracts (1); development of focal incipient primary cataracts (2); formation of vitreous opacities (1); and development of a unilateral optic nerve coloboma (1).

Animals↗
PubMed1995

Variation in ophthalmic testing prior to cataract surgery. Results of a national survey of optometrists. Cataract Patient Outcome Research Team.

OBJECTIVE: To assess variation in optometrists' use of ophthalmic tests in the evaluation of patients being considered for cataract surgery who have no history of other eye disease. DESIGN/PARTICIPANTS: National survey of a systematic sample of practicing members of the American Optometric Association (St Louis, Mo), who had referred at least one patient to an ophthalmologist for consideration of cataract surgery in 1991. RESULTS: Ninety-two of 130 eligible responding optometrists reported that they routinely performed preoperative testing on patients being considered for cataract surgery. Of these 92 optometrists, 91 (99%) frequently or always performed refraction, and 82 (89%) frequently or always performed a dilated fundus examination in their evaluation of patients being considered for cataract surgery who had no history of other eye disease. None of these 92 optometrists reported using B-scan ultrasonography or electroretinograms frequently or always, and few used A-scan ultrasonography or visual evoked responses frequently or always. A substantial percentage frequently or always used formal visual field testing (47%), formal color vision testing (40%), fundus photography (24%), potential acuity measurement (25%), glare testing (23%), contrast sensitivity testing (19%), and specular microscopy (14%), while 11% to 81% of optometrists never performed these tests on such patients. More recent graduation from optometry school was associated with a decreased frequency of use of potential acuity measurement and contrast sensitivity testing and with an increased use of dilated fundus examinations. CONCLUSION: There is a substantial variation in optometrists self-reported use of a number of ophthalmic tests in the preoperative evaluation of patients being considered for cataract surgery who have no history of other eye disease.

Adult↗
PubMed1995

Five-year incidence and disappearance of drusen and retinal pigment epithelial abnormalities. Waterman study.

PURPOSE: To obtain 5-year longitudinal data on age-related macular degeneration (AMD) that might be useful for disease prognosis, public health planning, and clinical trial development. PATIENTS AND METHODS: Baseline (1985) and 5-year follow-up (1990) fundus photographs of 483 watermen over 30 years of age who participated in a cohort study conducted on the eastern shore of Maryland were graded independently in a reliable, standardized fashion. Eyes in which AMD appeared or disappeared also were graded in a side-by-side fashion. RESULTS: Development of definite choroidal neovascularization and/or disciform scarring occurred in one of 50 participants over 70 years of age, specifically one of 15 participants over 70 years of age with AMD-3 (defined as large or confluent drusen focal hyperpigmentation of the retinal pigment epithelium [RPE], and/or nongeographic atrophy of the RPE). Appearance of large drusen, focal hyperpigmentation, or AMD-3 was age related, occurring in 5%, 1%, and 7%, respectively, of participants aged 50 to 59 years; 17%, 3%, and 14%, respectively, of participants aged 60 to 69 years; and 17%, 9%, and 26%, respectively, of participants aged 70 years or more. Disappearance of large drusen, hyperpigmentation, or AMD-3 occurred in 16 (34%) of 47 participants, 11 (58%) of 19 participants, and 17 (28%) of 61 participants, respectively, who had each feature photographically present in 1985. Among the 47 eyes identified in which AMD-3 developed by independent gradings, 38 cases of AMD-3 (81%) were confirmed on side-by-side grading. Among the 16 eyes identified as having AMD-3 that disappeared, nine disappearances (56%) were confirmed. Borderline differences in appearance of pigment, drusen size, drusen location, or photographic quality may have accounted for disappearance in seven cases (44%). CONCLUSIONS: Prospective studies on the nonneovascular features of AMD (including large drusen and abnormalities of the RPE) must account for the appearance and disappearance of these features and support the idea that side-by-side gradings can complement independent gradings identifying appearance or disappearance of features of AMD.

Adult↗
PubMed1995

Cataract surgical techniques. Preferences and underlying beliefs.

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.

Adult↗