EUREQUO Evolves

European guidelines for cataract surgery, benchmarking, and pioneering outcomes research are just some of the proven benefits of the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO), said Maartje Segers MD. Established in 2007 and including data on nearly 5 million cataract and nearly 250,000 refractive surgeries, EUREQUO has grown into the world’s largest multinational registry of cataract and refractive surgery.

And it is poised to help improve clinical practice outcomes even further, Dr Segers added.¹ EUREQUO “not only stores information, but it also organises it in a structured way, [helping us] track outcomes and compare them with colleagues,” she observed. The registry is continuously improving to provide up-to-date information, guide practice, and improve outcomes.

Guidelines and practice impact

Creating Europe’s first continent-wide evidence-based cataract surgery guidelines was among the biggest wins for EUREQUO. First published in 2012, the guidelines are based on data collected from more than half a million surgeries between 2009 and 2011.² They are under ongoing review for updates as the database grows and includes more complete and structured information about surgeries, Dr Segers noted.

Widespread adoption of intracameral antibiotics is one practice change encouraged in part by EUREQUO-enabled guideline adherence monitoring, Dr Segers said, which is reflected in the registry’s documentation of a dramatic decrease in endophthalmitis rates.

Similarly, EUREQUO outcomes data suggested no benefit from using femtosecond (FS) lasers in cataract surgery.³ This also appears to have changed practice, as evidenced by an initial spike in FS laser-assisted surgery followed by a sharp decline and gradual adoption, Dr Segers said.

Other EUREQUO studies have examined topics ranging from risk factors for refractive errors after surgery to the likelihood of cataract surgery after vitrectomy to complications related to posterior capsule rupture and anaesthesia techniques. A prospective study of bilateral toric IOL implantation is currently underway. 

Additional research questions include practice variation and post-marketing surveillance, Dr Segers said. These could help identify promising technologies and clinical best practices, potentially improving cataract surgery outcomes across the continent.

Strengthening the database

Improving data collection and interoperability is a complex but necessary challenge to make registries more useful. EUREQUO is responding by adopting structured data entry forms and collaborating with national registries, in part through the International Consortium for Health Outcomes Measurements (ICHOM), which helps standardise data structure, Dr Segers said. “Data entry needs to be as easy as possible.”

She added that the next step is automating data collection through integration with practice electronic records, which requires improving interoperability among data systems,
including standardising digital imaging in collaboration with industry. To help, EUREQUO has partnered with IQVIA, an organisation that supports manual, file upload, and automated data collection methods. Digital patient-reported outcomes such as Catquest-9 and NEI VFQ-25 and digital images are also supported.

Automated data collection is further enabled through a new collaboration with the European Health Data Space, which sets standards for interoperability and security. “We hope this will make the cross-border collection of data much easier,” Dr Segers said.

Encouraging surgeon participation is also a priority. Streamlining care pathways—by building data connections among referring practitioners and surgeons, for example— is an important step to capture data before and after surgery, she said.

Working with young ophthalmologists is another, Dr Segers added. “EUREQUO allows young ophthalmologists to benchmark their cases against [surgeons] in other countries.” It’s an approach she said helps build the practice of examining outcomes to improve care across the board.

Dr Segers spoke at the 2025 ESCRS Annual Congress in Copenhagen.

Maartje Segers MD is a PhD candidate and ophthalmology resident at the University Eye Clinic Maastricht at Maastricht UMC+, Netherlands.
maartje.segers@mumc.nl 

1. Segers MHM, et al. NEJM Catal Innov Care Deliv, 2024 Nov; 5(11). doi:10.1056/CAT.24.0029.
2. Lundstrom M, et al. J Cataract Refract Surg, 2012 Jun; 38(6): 1086–1093.
3. Manning S, et al. J Cataract Refract Surg, 2016 Dec; 42(12): 1779–1790.