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Survey finds similar practice patterns on America, Europe
Doctors on both continents compared as a group, although individual countries may vary.
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VIENNA, Austria — 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 survey question to ESCRS members, and used the same language between the two surveys to make 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 are more important as units and need to be looked at individually, he said that his purpose was to compare the two societies.
“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 majority of surgeons use topical anesthesia (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 predominately use the 12-o’clock incision (47%). ASCRS members most frequently use temporal incisions now (43%) superceding the 12-o’clock incisions for the first time.
Dr. Leaming also surveyed members about the distance of the incision from the limbus, and said, “The societies are very comparable.” 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 mostly acrylic lenses, which is another first among 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 | Best IOL optic material |
What operation and when? | Cataract incision location |
PRK volume per month | What operation and when? |
Cataract incision | LASIK volume per month |
What operation and when? |
For Your Information:
- David Leaming, MD, practices at 1100 N. Palm Canyon Drive, Ste. 112, Palm Springs, CA 92262; (760) 320-7051; fax: (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.