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Survey finds similar practice patterns in America, Europe
Doctors on both continents compared as a group, although individual countries may vary.
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VIENNA — Comparisons between the American and European cataract and refractive societies showed the groups are more similar than different, even though individual European countries may vary more often.
David Leaming, MD, expanded his American survey of physician practice patterns to cover the European Society of Cataract and Refractive Surgeons (ESCRS). He took this group and compared it side by side with the American Society of Cataract and Refractive Surgery (ASCRS).
For the American study, Dr. Leaming mailed the survey to the 5,000 members of ASCRS in September 1998. He received 1,450 (29%) in return. He then questioned ESCRS members during the annual meeting in Nice, France, in September 1998. About 400 members (25%) completed the survey.
Dr. Leaming asked a subset of the ASCRS surveys question to ESCRS members, and used the same language in both surveys to allow direct comparisons between the practice habits of the European and American society members.
For the ESCRS surveys, Dr. Leaming broke down responses by nationality and found a mostly even distribution. While the single country surveys can be looked at individually, he said that his purpose was to compare the practice patterns of two societies as a whole.
“This survey is just of the membership of the ESCRS and it’s not intended to replace any of the individual countries,” he said. “It just gives an overview of the entire society.”
Cataract procedures
In both societies, the most popular form of anesthesia is topical (43% for ESCRS, 41% for ASCRS). Periocular options are a little more popular among ASCRS members (18% for ESCRS, 27% for ASCRS). ESCRS members use general anesthetic more often than ASCRS members (4% versus 0.2%).
Cataract incision locations also were similar. ESCRS members predominantly use the 12-o’clock incision (47%). ASCRS members most frequently use temporal incisions now (43%), superseding the 12-o’clock incisions this year for the first time.
Dr. Leaming also surveyed members about the distance of the incision from the limbus. “The societies are very comparable,” he said. ESCRS members use clear corneal incisions in 38% of procedures, while ASCRS members use clear corneal incisions in 36%. Another 20% of members in each society use incisions anterior to the limbus.
ESCRS members inserted silicone lenses in one-half of all cases, followed by PMMA (34%), acrylic (10%), hydrogel (4%) and other (2%). ASCRS members used acrylic lenses most often, which is another first among the American surgeons for the 1998 survey.
“PMMA had, in all previous years, been the number one lens material of choice,” Dr. Leaming said.
Refractive procedures
The volume of photorefractive keratectomy (PRK) was another similarity between members of ESCRS and ASCRS, Dr. Leaming said.
“There are slightly more ASCRS members doing PRK than ESCRS members,” he said. “With laser in situ keratomileusis (LASIK), we see that approximately one-third of the membership are doing LASIK, and that the lines are fairly comparable between the two societies.”
Dr. Leaming asked members of each society how they advise patients on refractive procedures based upon degree of refractive error.
“For the 4 D myope, it’s of interest in the ESCRS. There’s a higher percentage who would recommend no surgery at all (31% ESCRS, 4% ASCRS),” Dr. Leaming said.
Among ESCRS members, 38% recommended PRK, compared with 33% of ASCRS members. Also, 25% of ESCRS members recommended LASIK, compared with 50% of ASCRS members.
“For a –7 D myope, both societies would recommend LASIK but a higher percentage in the ASCRS (79%) than ESCRS (66%),” he said. “Still, around 13% to 14% would recommend no surgery in the ESCRS. And for the 12 D myope again, LASIK was preferred; however, a significant percentage would recommend waiting (36% for ESCRS, 33% for ASCRS).”
| Type of block Topical is most popular | Cataract incision location What axis? |
Cataract incision location Distance from limbus | IOL optic material Silicone, acrylic lead in Europe, U.S. |
PRK volume per month Comparisons of ESCRS and ASCRS | LASIK volume per month Comparison of ESCRS and ASCRS |
What operation and when? Advice to -4 D myope | What operation and when? Advice to -7 D myope |
What operation and when? Advice to -12 D myope |
For Your Information:
- David Leaming, MD, practices at 1100 N. Palm Canyon Drive, Ste. 112, Palm Springs, CA 92262 U.S.A.; +(1) 760-320-7051; fax: +(1) 760-320-7059. Dr. Leaming has no direct financial interest in any of the products mentioned in this article. He is a paid consultant for Alcon, Pharmacia & Upjohn, Bausch & Lomb, Allergan and Visx.