Long-Term Data Key to Surgical Success

Long-term data collected by eye care registries are important for monitoring the safety and effectiveness of, and patient satisfaction with, cataract surgery. The insights gained inform advances in surgical techniques and technologies and guide preoperative decision-making, patient selection, and patient counselling, said Flora Lum MD.

In the US, the IRIS^® Registry (Intelligent Research in Sight), run by the American Academy of Ophthalmology, tracks eye care across all types of ophthalmic practices. Launched in 2014, the registry now includes about 70% of US ophthalmologists and is integrated with practice electronic health record systems. It currently includes data on more than 800 million visits by nearly 86 million unique patients spanning as long as 12 years, Dr Lum said. The IRIS Registry uses a randomly generated, unique patient identifier number to enable tracking of individual patients across practices—yielding greater information on how cataract surgery affects other ocular conditions over time.

For example, its data show that within 1 year of cataract surgery, retinal detachments occur in about 0.21% of cases and retinal tears in about 0.17%. Because the IRIS Registry is integrated with electronic health records from retina and cataract practices, it also has identified several risk factors. Lattice degeneration is the most significant, increasing risk about 10-fold. High myopia, hypermature cataracts, complex cataract surgery, and posterior vitreous detachment all add risk as well.¹

Similarly, data from nearly 2 million cataract patients show that those with higher intraocular pressure (IOP) immediately after cataract surgery have about double the risk of developing primary open-angle glaucoma (POAG) compared with normal IOP patients, with a median time to glaucoma diagnosis of 682 days. And the higher the IOP, the greater the risk.²

“Elevated postoperative IOP is a risk factor associated with future POAG development that is independent of age, sex, race, and ethnicity,” Dr Lum said, advising surgeons to monitor patients who had high postoperative IOP spikes after cataract surgery for potential glaucoma development.

IRIS Registry studies also show that children with aphakia and a history of trauma are at higher risk for retinal detachment after cataract surgery.³ Those with a history of trauma, uveitis, or retinopathy of prematurity have higher risk for visual axis opacification, and anterior vitrectomy reduces the risk somewhat.⁴

Such insights guide practice and follow-up, allowing surgeons to make better treatment decisions and counsel patients on what to expect. Long-term follow-up also improves understanding of patient experience over time, flags complications to watch for, and highlights opportunities to improve treatments and evaluate devices and pharmaceuticals. Ultimately, this improves long-term surgical outcomes and patient satisfaction, Dr Lum concluded.

Dr Lum presented at the 2025 ESCRS Annual Congress in Copenhagen.

Flora Lum MD is vice president of quality and data science at the American Academy of Ophthalmology. flum@aao.org

1. Morano MJ, Khan MA, Zhang Q, et al. Ophthalmol Science, 2023; 4: 100314.

2. Gim N, Jian Y, Bagdasarova Y, et al. Ophthalmol Science, 2025; 5: 100851.

3. Altamirano F, Jeon JH, Lee J-Y, et al. Ophthalmology, 2025; 132: 888–894.

4. Lee J-Y, Jeon JH, Altamirano F, et al. Ophthalmology, 2025 Jun 27: S0161-6420(25)00392-6. Online ahead of print.