New findings from a study published in Optometry and Vision Science evaluated the rate of complication 1 week after uncomplicated phacoemulsification to determine if a postop visit is actually necessary.
Give me some background first.
Cataract surgery is the most common and widely performed ophthalmic procedure in developed countries, accounting for up to 50% of all ophthalmic procedures performed in the United States.
However, there is currently a lack of scientific evidence supporting the medical necessity of the traditional postoperative follow-up schedule.
Now talk about the study.
In this retrospective study, a record review was performed on all consecutive patients who underwent uncomplicated phacoemulsification between February 1, 2019, and February 1, 2020.
The clinic selected for this study was located in an urban setting and served a predominantly Black and African-American patient population.
Anything else?
All patients included in the study underwent phacoemulsification with one surgeon affiliated with the Illinois Eye Institute at the Illinois College of Optometry in Chicago.
What were the patient inclusion criteria?
Of 506 phacoemulsification surgeries, 72 eyes met the inclusion criteria, which required that patients have no complications at the postoperative day one exam.
Most patients were excluded because they either did not adhere to the postoperative appointment schedule or reported a complication at the postoperative Day 1 exam.
Findings?
Omitting the 1-week postoperative examination would result in missed complications in 4.48-15.97% of patients and a failure to make unexpected management changes in 1.78-13.84% of patients.
Go on…
There was no statistically significant difference in the total complication rate between postoperative Week 1 (95% confidence interval [CI] 0.0448-0.1597) and postoperative Month 1 (95% CI 0.0019-0.1015).
Of note, some complications observed at Week 1 were treated, so the lack of statistical difference between the two should not be interpreted as evidence to omit the postoperative Week 1 examination.
Potential challenges of nixing the postop exam?
The study authors noted the following logistical management challenges:
- Early identification of endophthalmitis
- Reviewing the refractive outcome of the first eye surgery and making adjustments prior to phacoemulsification for the contralateral eye
- Adjusting the postoperative medication regimen, thereby potentially decreasing adherence to the treatment regimen
Could telemedicine help with postop care?
Some of the issues mentioned above could be addressed with a telehealth visit, where the treatment instructions and regimen are reviewed.
However, quality studies are needed to evaluate the mode, content, safety, and efficacy of telemedicine postoperative examinations.
What else?
Standardized symptom screening would need to be developed and validated before scheduling postoperative telemedicine appointments.
A survey for telemedicine appointments could include questions relating to:
- Patient’s quality of vision
- Pain
- Photophobia
- Redness
- Discharge
- Eyelid swelling
- Adherence to pre-and postoperative medication instructions
Could phone surveys replace in-person visits?
A 2014 study found that a nurse-administered telephone survey was a safe and effective alternative to the in-person postoperative day-one examination.
A similar 2016 study demonstrated that patients reported a high rate of satisfaction with the telephone follow-up, with 75.5% of patients preferring the telephone follow-up to an in-person postoperative examination.
Limitations?
The study was designed to assess a narrow group of patients who were at low risk of postoperative complications.
Due to the strict inclusion and exclusion criteria, 86% of patients in the original cohort were excluded from the analysis. As a result, the findings of the study could not be universally applied.
Take home.
The study authors concluded this data supports continuing the practice of performing 1-week postoperative examinations after uncomplicated phacoemulsification.
They also point to the potential of telemedicine and/or telephone surveys as being safe substitutions for in-clinic postoperative examinations, though further research is still needed.
Next steps?
Further studies with larger sample sizes, multiple surgical sites, and surgeons with a variety of experience and surgical techniques are required to validate and streamline postoperative care.