Pre- And Postoperative Management After Cataract Surgery: Current State In Europe

Cataract surgery is a safe and well-established procedure. Even though postoperative complications after routine uneventful cataract surgery are rare, considerable resources are dedicated to postoperative follow-ups. This may not only cause substantial costs but is also associated with a meaningful carbon footprint mainly due to patient travel. This study aims to investigate the pre- and postoperative management of patients undergoing cataract surgery in Europe.

A questionnaire of the Young Ophthalmologists for Sustainability (YOFS) was shared across European ophthalmology units.

Centers were asked to share treatment pathways for patients undergoing routine uncomplicated cataract surgery having no significant ocular comorbidities. Evaluated aspects included pre- and postoperative visits, time and location of follow-ups, proportion of delayed sequential bilateral cataract surgery (DSBCS), and immediate sequential bilateral cataract surgery (ISBCS) surgeries. To assess the number of post-operative visits, centers were asked to include all examinations by health care professionals (ophthalmologists, optometrists, opticians) both at the surgical center and in local setting(s).

In total, 89 responses from 16 European countries were collected. Most departments perform 2.000 to 5.000 cataract surgeries per year; if ISBCS is offered (n=37), this commonly accounts for less than 5% of cases. The number of preoperative visits varied between 1 (78%) and >3 (2%), with the majority (55%) performing preoperative visits also before surgery on the second eye. 1 to 4 postoperative visits were commonly performed, with most centers performing 1 (35%) or 2 (45%). Taking pre- and postoperative visits together, the average was 5.74 for DSBCS and 2.84 for ISBCS with large differences between countries (range: 3,33-9,25 [DSBCS]; 2-4 [ISBCS]). Remote follow-up visits were offered only by few centers (n=6).

This study shows large differences between European countries regarding the frequency of pre- and postoperative visits for cataract surgery. As several studies have shown that, for instance, postoperative follow ups can be reduced after uneventful cataract surgery without increased patient risk, (regional) reconsideration of treatment pathways appear vital. Less visits may not only reduce the workload of healthcare providers, but also enhance sustainability, especially by reducing CO₂ emissions due to travel. Sustainability may (potentially) also be enhanced by novel approaches such as virtual visits.