HELPING TRAINEES

The European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO), which is designed to improve standards of care as well as develop evidence-based guidelines for cataract and refractive surgery across Europe, has much to offer young ophthalmologists. Training in cataract surgery can be an exciting and daunting experience. It is difficult to think about outcomes when you cannot even complete all the steps without a supportive tutor scrubbed by your side, steering you away from trouble and towards the safe completion of the case.

Ophthalmology trainees need to keep an up-to-date logbook of all the operations they carry out as a record of their surgical training. Most surgical logbooks are a record of the surgical work carried out but not of the outcomes of surgery. However, it is worth starting to think about your cataract surgery outcomes early. Your outcomes will tell you which steps of the surgery you need to work on and where you need to improve. In fact, self-audit is something you will have to do all the time when you qualify as an independent surgeon, so it is worth getting into the habit early.

EUREQUO is an Internet-based application that allows you to do just that and makes it easy. It keeps a record of the cataract operations you carry out, including the visual and refractive outcomes and both intraoperative and postoperative complications. It allows you to print reports and compare your results from year to year or from rotation to rotation even if you move hospitals. A report can be produced with ease and speed for your six-monthly or yearly appraisal. In addition, EUREQUO allows you to compare yourself with other EUREQUO users in your own country and the rest of the world. The fact that benchmark standards based on EUREQUO data are now available gives the trainee surgeon a standard to aim for.

As EUREQUO is web-based, it can be accessed on any computer with an Internet connection. I personally find that the easiest way to enter my cases is on my smartphone as I always have it with me. I enter the preoperative and intraoperative data on the day of the surgery and the postoperative data at the two- to three-week postoperative visit. As not all fields are compulsory, the surgeon can choose to enter just a small number of compulsory fields if pressed for time, and still log the case. However, you get a lot more information on your surgery if you make the effort to fill in as many fields as possible. The compulsory fields take three minutes to fill in, while if you wanted to fill in all the fields, it would take about six minutes.

I always try to see my postoperative patients myself and I would advise all trainees to do the same, both in cataract and any other eye surgery. It is the only way to know how well or not you are doing and where you need to improve. In cases where I cannot see the patients myself, I leave clear postoperative instructions for unaided and best-corrected visual acuity, as well as for refraction to be checked so that no postoperative data is missed. Auditing your surgical results should be as essential as writing the operative note. EUREQUO is a great way for trainees to audit their cataract surgery, helping them to focus on areas to improve on and goals to achieve, preparing them for a lifetime of audit as qualified surgeons.