FRENCHSURVEY

The growing popularity of the femtosecond laser, a marked trend towards higher-volume cataract surgery to cater for an increasingly older population and a significant increase in the use of toric intraocular lenses (IOLs) are some of the more pertinent findings of the latest survey of French ophthalmologists conducted by Richard Gold MD.

In the 18th annual survey of French practices in ophthalmic surgery, Dr Gold, in private practice in Le Raincy, France, collected 547 responses to an anonymous questionnaire sent to 2,996 French ophthalmologists. The response rate of 18.32 per cent was a significant improvement on last year’s all-time low of 12.55 per cent, but is still the second lowest response rate since the study was initiated, said Dr Gold.

The proportion of French ophthalmologists with a low volume of cataract surgery continues to decline, with about six per cent performing fewer than 100 cataract surgeries per year, down from 22 per cent in 1998 and 10 per cent in 2007. The most striking trend has been the proportion of surgeons performing higher-volume cataract surgery. While only 16 per cent performed between 500 and 999 procedures annually in 2004, that figure has risen to almost 27 per cent in 2014.

“This is not surprising given the reduced number of ophthalmologists in France and the fact that the population is getting older,” said Dr Gold. Reflecting the wider global trend, the size of the incisions used by French ophthalmic surgeons for cataract surgery has steadily decreased in recent years, with the percentage of microincisions of less than 1.8mm being performed stabilising between five per cent and six per cent in the past few years.

The number of surgeons using an incision size between 1.8mm and 2.2mm has climbed steadily from 25 per cent in 2009 to over 58 per cent in 2014. Oblique incisions also became the preferred choice (32 per cent) ahead of temporal incisions (29 per cent) for the first time since the survey began.

Looking at premium IOL usage, Dr Gold noted that while growth has been relatively linear for multifocal and add-on IOLs in recent years, toric lenses have become increasingly popular, with over 45 per cent of respondents in 2014 implanting toric lenses compared to 13 per cent in 2008.

The use of intracameral antibiotics in cataract surgery is now almost universally applied in France, having been made obligatory by the national health authority in 2011. Aprokam cefuroxime is the antibiotic of choice in 82 per cent of cases, and reconstituted cefuroxime in 17.5 per cent.

An increasing proportion of French surgeons now use refractive surgery for the treatment of presbyopia.

Finally, Dr Gold noted that the age profile of France’s ophthalmologists continues to cause concern, with not enough young ophthalmologists joining the ranks of the profession, which raises serious concerns for the ocular health of the population in the years to come.

Richard Gold: rg@ophtalmo.net