Ophthalmologist, treat thyself

When it comes to choosing anaesthesia, intraocular lens type and other key aspects of cataract surgery, what would ophthalmologists choose for their own cataract procedures and how would their choices compare to actual real-world practices? The answer, according to a study presented by Raphaël Barugel MD at the annual meeting of the French Implant and Refractive Surgery Association (SAFIR) in Paris, France, is that the majority of ophthalmologists would prefer manual phacoemulsification under sedation with a monofocal hydrophobic implant targeting emmetropia and with the use of a prophylactic intracameral antibiotic. “There were some interesting findings, particularly the high percentage of ophthalmologists who said that they would select a multifocal lens for their own surgery, which is at variance with the very small number of multifocal IOLs that are actually implanted every year in France,” he said. Dr Barugel’s study was based on 264 responses to a questionnaire distributed to ophthalmologists in France between November 2017 and May 2018. The questionnaire comprised 14 questions relating to the key steps of cataract surgery including choice of implant (monofocal/multifocal, white/yellow filter, hydrophobic or hydrophilic), targeted refraction, anaesthesia, antibiotic prophylaxis and surgery type (manual or femto-cataract). Respondents were also asked about their type of practice and the volume of cataract surgeries, if any, that they performed every year. In terms of preferred IOL, 74% of respondents said they would choose a monofocal implant for their own surgery, while 25% said that they would opt for a multifocal lens. “When we look at real-world practice, we see that only around 5% of IOLs implanted in 2016 were multifocal implants so there is quite a large discrepancy there between what ophthalmologists would choose for themselves compared to what they actually implant for their patients,” he said. Almost 91% of respondents said they would prefer standard manual phacoemulsification to femto-cataract. Of those 8.8% who would opt for a femto-cataract procedure, some 46% preferred a multifocal IOL, compared to 23% for those who selected manual surgery. Over half (55%) of respondents said they would choose intraoperative sedation, and 83% said they would request intracameral antibiotic prophylaxis. Dr Barugel noted that the preferences expressed by the ophthalmologists were usually in line with the precepts of evidence-based medicine (i.e. preference for hydrophobic versus hydrophilic lens material) while the choices were more nuanced when debate was still ongoing (i.e. choice of white or yellow filter IOLs). While the study had clear limitations, Dr Barugel added that it would nevertheless be interesting to perform similar studies for other aspects of ocular surgery, in particular refractive surgery, in order to shed some light on preferred treatments for presbyopia where multiple options are currently available to patients. Raphaël Barugel: rbarugel@yahoo.fr