ESCRS to Release Guidelines for Cataract and Refractive Surgery

The ESCRS will soon release comprehensive cataract and refractive surgery guidelines. A workshop held during the ESCRS Winter Meeting in Frankfurt focusing on the cataract side featured co-chairs Filomena Ribeiro MD, PhD (Lisbon); Oliver Findl MD (Vienna); Sorcha Ní Dhubhghaill MD, PhD (Brussels); Alexander Day MD, PhD (London); and Anders Behndig MD, PhD (Umeå, Sweden).

The purpose of the ESCRS Cataract and Refractive Surgery Guidelines is to address the value of diagnostic and therapeutic steps for various stakeholders in the patient pathway. The guidelines will provide explicit, evidence-based recommendations and insights that healthcare providers should follow to deliver high-quality care. The clinical recommendations are crucial for supporting clinical decision-making and promoting better care, transparency, and reduced unwanted practice variation.

Joukje Wanten PhD, Maastricht University, Netherlands, discussed the methodology being used to create the guidelines.

“The goal of the guidelines is to highlight both the diagnostic and therapeutic steps in cataract treatment,” she said. “This includes screening and patient selection, preoperative assessment, perioperative procedures, postoperative care, and complications. It is intended for all stakeholders working in the cataract field. We want to provide explicit and evidence-based recommendations and insights that healthcare providers should follow to deliver optimal care.”

The session began by reviewing the key steps to designing the guidelines, like the use of PICO questions, a standard approach when considering evidence-based treatments. The “P” stands for patient, population, or problem; the “I” for intervention; the “C” for comparison or control; and the “O” for outcome or objective. This line of questioning ensures key outcomes are defined in the guidelines. Next comes a systematic literature search. After appraising the literature, the evidence can be graded and recommendations considered.

Grading the evidence is a key step in creating the guidelines. Evidence is rated from high strength—very confident the true effect of an intervention lies close to the observed effect—to very low strength, where the true effect is likely substantially different from the observed effect.

“We assessed all available randomised clinical trials and systematic reviews to define the strength of the evidence available,” reported Victoria Kauer PhD, Hanusch Hospital, Vienna. “From the evidence, we can generate recommendations. All the recommendations are based on the lowest grade suggested by the evidence.”

The ESCRS cataract guidelines working group is applying this approach to every aspect of modern cataract surgery. For example, after applying the process to immediate sequential bilateral cataract surgery (ISBCS), the analysis determined ISBCS provides comparable clinical outcomes to conventional delayed sequential bilateral cataract surgery (DSBCS). Moreover, ISBCS offered the advantage of faster patient rehabilitation, avoiding the suboptimal visual function associated with DSBCS. Relative contraindications would include if there were an increase of peri- or postoperative complications or if complications occur in the first eye surgery.

Other examples of questions the workgroup considered include the value of femtosecond laser cataract surgery, optimal treatments for corneal astigmatism, and the most effective approaches to reduce postoperative inflammation.

The full cataract guidelines are expected to be announced at the 2024 ESCRS Congress in Barcelona, 6–10 September, with guidelines for refractive surgery to follow later.