The Cataract Surgeons Of Tomorrow – How Are They Doing? An Audit Of The Last Decade Of Early Training

Changes enacted throughout the NHS aiming to reduce the strain of healthcare demands has changed the scope of NHS workload. For instance, the increased utilisation of independent sector cataract clinics concentrated complex cases to hospital settings and reduced training opportunities. As cataract surgery requires sufficient case volume to achieve optimal surgical outcomes, these shifts may affect surgeon development especially in the early stages. We retrospectively audited cataract surgeries from 2015–2026, comparing case‑mix and outcomes for residents in their first 3 years to consultants. The aim was to assess how early cataract surgical exposure has changed over time.

This study is set within a UK secondary care ophthalmology outpatient department within a multi-hospital training programme, composing of 3 other hospital trusts. Changes affecting this unit over the past decade are likely to be comparable to other UK district general hospitals. Anecdotally, independent sector expansion appears to have increasingly diverted routine cataract surgery and postoperative review to the community. As a result, the NHS now manages a greater proportion of complex cases.

Cataract surgeries recorded in the ophthalmologic electronic patient record database MediSIGHT (Medisoft Ltd, UK) from August 2015 to February 2026 were retrospectively audited. Data extracted included surgeon grade, patient demographics, comorbidities, complexity markers, and complication outcomes.

Complexity was defined as any ocular co-pathology which may contribute to surgical complexity, or intraoperative data that represented extra steps taken; such as the use of heavy or dispersive viscoelastic, or vision blue.

Chi-squared tests (or Fischer exact tests where data groups were <10) were used for analysis where data were discrete, and Wilcoxon rank-sum tests were used for continuous variables.

Twenty-four residents in their first three years of training completed 4,350 cases (13,915 departmental total). Resident cases fell from 2,194 in 2015-2020, to 1,303 in 2020-2026.

Average cases per six month block decreased from 67.0 to 43.1, number of theatre lists from 23.1 to 15.1, and cases-per-list from 2.77 to 2.64.

Complex cases increased overall from 9.65% to 21.7%, rising from 6.71% to 12.1% for residents, and 11.8% to 24.8% for consultants.

Despite more complexity in cases, secondary-care postoperative reviews declined in both groups; 71.1% of resident and 72.5% of consultant cases were reviewed initially, which fell to 59% and 65.6%, respectively.

Posterior capsular rupture (PCR) rates remained stable (2.10% to 2.38%; p=0.674).

Over the past decade, system‑level changes, particularly the expansion of independent sector cataract activity, have reduced early resident surgical volume while increasing the proportion of complex cases undertaken in NHS settings. Greater complexity may limit consultant capacity for supervised training, and the shift of postoperative care into the community may reduce feedback opportunities for surgeons in their early training. Stable PCR rates are reassuring, but a department with a high throughput of training surgeons may need to review their theatre activity to protect early operative experience and improve case volume for the surgeons of tomorrow.