Reaching Cataract Surgery Target Refraction: Ophthalmic Surgical Outcome Database Project Results
Purpose
To evaluate the percentage of cataract surgeries achieving their pre-operative target refraction within various tolerances. To assess for preoperative risk factors in not achieving target refraction.
Methods
Retrospective multi-center study of the Ophthalmic Surgical Outcome Database of 4923 cataract surgeries performed from April 2009 to February 2012. Cases were included if they had documented both a preoperative target refraction and a postoperative 30-day manifest refraction. Descriptive statistics on the difference between target refractions and 30-day manifest refractions were computed with Excel (Microsoft 2010). Multivariate logistic regressions were performed (SAS 5.1) to assess for preoperative factors which conferred an increased risk of not attaining target refraction.
Results
Of the 4923 cases in the OSOD, 4456 (90.5%) met inclusion criteria. These cases had a mean absolute target refraction difference of 0.47 diopters (D) with standard deviation of 0.48 D. At a tolerance of 1.0 D, 91.8% (4092 cases) achieved their target refraction. At tolerances of 0.75 D, 0.5 D and 0.25 D, 84.8% (3779 cases), 68.0% (3032 cases), and 36.9% (1644 cases) attained target refraction, respectively. Multivariate logistic regressions of preoperative factors showed that a history of previous ocular surgery (P = 0.0006) and the amount of preoperative astigmatism (P = 0.0225) exerted a significant negative effect on the probability of achieving target refraction at a tolerance of 1.0 D.
Conclusion
These results help define the current standards of achieving target refractions in cataract surgery. They provide the most robust current measure of outcomes given the large number of cases.