Researchers say most 1-day follow-ups for cataract surgery are unnecessary
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Researchers who analyzed current data on postoperative complications after uneventful phacoemulsification cataract surgery concluded that the postoperative 1-day follow-up may be unnecessary.
Elimination of the postoperative day-1 (POD1) follow-up could significantly increase health care saving with no increased risk to the patient, they said.
Using the PubMed literature database, researchers identified 45 articles published between 1994 and 2017 that highlighted any postoperative complications of phacoemulsification cataract surgery (PCS). Complications included corneal edema, postoperative uveitis, IOP elevation, cystoid macular edema and posterior capsule opacification.
Common alternatives to POD1 follow-up found in the literature included a nurse-administered telephone questioner, shared care with non-ophthalmologists and seeing patients with no complaints at a low threshold. Also, applying topical dorzolamide/timolol and brinzolamide after surgery is recommended, especially for patients who presented with preexisting optic nerve damage.
Researchers noted that the spikes in IOP occurred 3 to 7 hours after surgery. However, none of the treatments assessed in the studies protected patients’ glaucomatous eyes from elevated IOP.
They concluded there is nothing to suggest that POD1 follow-ups are necessary after uneventful surgeries by experienced surgeons.
Additionally, the researchers suggested that eliminating the POD1 follow-up would not increase patient risk and may also result in significant health care savings. – by Scott Buzby
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Sondra Black, OD, FAAO
With the advent of small incisions, foldable lenses and improved pharmaceuticals, cataract surgery has dramatically changed and become safer over the past decade. According to the authors’ research, superfluous tests and procedures are estimated to be as high as 30% of all health care spending. The question becomes then, does the patient who has had cataract surgery require the same frequency of postoperative care?
The authors collected and analyzed data from 45 articles between 1994 and 2017 to determine the nature and frequency of complications after routine cataract surgery. The most common complications included corneal edema, uveitis, IOP elevation, cystoid macular edema and posterior capsular opacification. The authors concluded that in uneventful phacoemulsification cataract surgery, in routine patients, and in the hands of an experienced surgeon, a day-1 postoperative visit is not supported by the literature.
To mitigate risk, they recommend telephone follow-up by a nurse, sharing care with “non-ophthalmologists (optometrists)” and seeing patients immediately who have a complaint. They also recommend use of a potent steroid, and in the case of patients with glaucoma, postoperative administration of topical dorzolamide/timolol and brinzolamide.
The authors feel that eliminating the postop day 1 visit could result in significant health care savings without any increased patient risk.
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