EUREQUO UPGRADE

With more than two million cataract cases (two million passed on 17 March 2016) recorded since its 2008 launch, the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) is shedding new light on ocular surgery practices and outcomes.

New variables added this spring – including data on cases lost to follow-up and questions specific to femtosecond laser-assisted cataract surgery (FLACS) – will make EUREQUO an even more useful and powerful research tool, explained Mats Lundström MD, PhD, who is clinical director of EUREQUO.

“In some countries patients may go to an optometrist instead of the clinic for follow-up, and this makes it very difficult for surgeons and clinics to deliver follow-up data,” Dr Lundström said.

The flexibility to enter cases without follow-up, or to complete cases by adding follow-up data later, will enable the registry to capture information on preoperative indications and surgical complications for a large number of procedures excluded under previous data entry rules, he added.

To better track outcomes and complications for femto-cataract surgery, EUREQUO can now collect data on laser use for corneal incisions, capsulotomy, nuclear fragmentation and astigmatism treatment. Laser-specific complications, including docking failures and laser issues such as skips, may also be recorded. “There are a pretty large number of new variables for those,” said Dr Lundström, of Lund University, Sweden.

NEW CATEGORY

On the refractive side, new variables include use of mitomycin C in corneal refractive surgery, the type of intraocular lens used in refractive lens exchange, intended monovision, and information on the small incision lenticule extraction (SMILE) procedure. EUREQUO has also built an automated data interface with Memira AB (which operates 45 refractive surgery units in Scandinavia), which Dr Lundström believes will yield about 25,000 new records annually to the refractive database. This now includes about 40,000 cases.

Discussions are under way to build similar data interfaces with other large refractive surgery chains, he added.

A new category has been added for surgeons in training. This will allow ocular surgery residents to track and more easily compare their outcomes with other trainees, Dr Lundström said.

Later this year, patient-reported outcomes will be added for the first time, Dr Lundström said. Initially, these will include information regarding vision-related limitations on activities of daily living and quality of life, such as reading newspapers, driving, watching television and recognising faces - both for cataract and refractive surgery.

BIG DATA INSIGHTS

Mining the two million EUREQUO cataract cases collected from centres in 18 countries is already yielding important clinical insights, particularly for rare complications and unusual combinations of risk factors, Dr Lundström noted. For example, analysis of “refractive surprise” cases, in which visual outcome was 2.0 dioptres to 6.0 off target, identified several significant risk factors. These are poor pre-op visual acuity (VA), younger age, myopic target refraction, ocular comorbidities and surgical difficulties such as previous corneal refractive surgery or corneal opacities.

Moreover, adding risk factors multiplies the risk. Among patients with the three risk factors of pre-op VA of 20/200 or worse, age below 70 years, and target refraction of -2.0D, 9.5 per cent experienced refractive surprise. Adding glaucoma to the three raised the rate to 13.3 per cent, while adding amblyopia to the three raised it to 17.9 per cent. Adding corneal opacities increased it to 28.6 per cent. Without a large number of cases it would be difficult to detect how these unusual combinations affect outcomes, Dr Lundström said.

Examining registry outcomes also complements randomised controlled trial results by recording outcomes among patients with conditions excluded in controlled studies, Dr Lundström said. “Using the registry like this you will find out what works in real life.”

Patient-reported outcomes will yield information valuable for counselling patients on the trade-offs of various surgical options, Dr Lundström added. “With a multifocal lens, you may have more optical symptoms but have a nice convenience because you are spectacle free.”

Eventually, EUREQUO will expand to include data on other conditions, such as corneal transplant surgery (an agreement with the EU has recently been signed) and maybe paediatric cataract surgery, Dr Lundström said. Other plans involve to use EUREQUO as a case report form in a clinical study about toric intraocular lenses (similar to the FLACS study).

Mats Lundström, clinical director of EUREQUO:

mats.lundstrom@karlskrona.mail.telia.com