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Subspecialties Cataract

The Matchmaker

At a Glance

  • In the UK, cataract surgery is often performed by trainees – with complication rates two- to three-fold higher than consultants
  • We have devised a cataract surgery scoring system to stratify patients according to risk, categorize surgeons by experience, and match patients to surgeons accordingly
  • Data from over 8,000 cases shows that our system removed the association between case complexity and posterior capsule rupture, and almost completely eliminated outcome differences between trainees and consultants
  • Our system reduces cataract surgery complications, assists practice management and ensures compliance with recent NICE guidelines. We believe the concept is also applicable to other surgical procedures.

Cataract surgery is very safe – but it could be even safer. A third of all cataract procedures in the UK are performed by trainees; junior trainees have posterior capsule rupture (PCR) rates of 3.2–5.1 percent (1)(2)(3), which compares poorly with the overall PCR rate of 1.9 percent. Intuitively, we all know we could improve this situation by protecting less experienced trainees from more difficult cases. But how can we do this in practice? In my clinic, we have been matching surgeons to cases on a rational basis for nine years – and our retrospective data analysis (4) shows a significant reduction in complications.

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About the Author

Paul Ursell

Paul Ursell is a consultant ophthalmologist at Epsom & St Helier University NHS Trust, Surrey, UK.

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