PRACTICE PATTERNS

Nearly half of Canadian cataract surgeons corrected astigmatism at the time of surgery in 2012, with more than 80 per cent of those using toric lenses, according to a survey by Lindsay Ong-Tone MB, CHB, FRCSEd, FRCOphth, FRCSC, of the University of Saskatchewan, Canada. Canadian surgeons are also embracing non-steroidal anti-inflammatory drops before and after cataract surgery.

In 2012, 63 per cent prescribed NSAIDs preoperatively with most starting two to three days before surgery, according to the fourth annual survey of Canadian Ophthalmology Society members, which had a 30 per cent response rate. Nevanac (nepafenac ophthalmic suspension 0.1%, Alcon) was the most common choice.

Nearly 90 per cent also used steroid drops postoperatively, with prednisolone acetate the top choice, Dr Ong-Tone reported. However, NSAIDs are gaining for controlling postoperative pain and inflammation.

“It is interesting to note that about 10 per cent used an NSAID drop-only postoperatively while the use of steroid drops-only dropped gradually over the past four years, with a corresponding increase in the use of a combination of NSAID and steroid drops.”

Comparing data        

Comparing 2011 Canadian data with ESCRS and ASCRS survey data collected by David Leaming MD, preoperative NSAID use was more common throughout North America than in Europe, as was the use of temporal incisions. The top lens material of choice in all three surveys was hydrophobic acrylic. However, hydrophilic acrylic took second place in Canada and Europe, at 26 per cent and 18 per cent respectively, while silicone was the second choice in the US at 16 per cent.

In Canada, the 1-piece aspheric hydrophobic acrylic lenses are gradually gaining popularity as use of the 1-piece aspheric hydrophobic lenses with blue blockers declines slightly, Dr Ong-Tone noted. Use of premium lenses increased in 2011, and maintained gains in 2012, with about 72 per cent using toric lenses and 38 per cent multifocal lenses.

At 66 per cent, intracamerally injected antibiotics were much more commonly used in Europe in 2011, more than double the Canadian rate of 29 per cent and triple the US rate of 18 per cent, though the US rate continued a gradual increase in 2012 to about 23 per cent (see graphic). For 2012, IC moxifloxacin use doubled to 67 per cent, supplanting vancomycin as the top choice in Canada, Dr Ong-Tone said.

About 80 per cent of Canadian surgeons also use antibiotic eye drops preoperatively, with most starting treatment two to three days before surgery, though about 16 per cent start on the day of surgery. The most common anaesthetic approach was combined topical with intracameral xylocaine, followed by topical xylocaine only.

Gradual trend            

Divide and conquer was the top Canadian nucleofractis technique at 42 per cent, followed by vertical chop at 23 per cent, Dr Ong-Tone said. “There is a slow, gradual trend toward divide and conquer with a relative decrease in the vertical chop technique over the years.”

In 2011, more than 13 per cent of Canadian surgeons reported doing simultaneous bilateral cataract surgery compared with eight per cent in Europe and 0.4 per cent in the US. In 2012, the percentage of US surgeons reporting same-day bilateral cataract surgery rose to 0.9 per cent for cataract surgery, while 4.1 per cent of those doing refractive lens exchange said they always try to do same-day bilateral surgery in patients seeking surgery in both eyes, Dr Leaming noted. Reimbursement arrangements may influence the choice as the US Medicare program pays less for a second surgery on the same day than on two separate dates. However, RLE patients also are generally younger and healthier than cataract patients, potentially making them better candidates for same-day bilateral surgery.