Outcomes of immediate sequential bilateral cataract surgeries (ISBCS) performed by trainees vs consultants: a two-armed cohort study.

Abstract

Purpose: To compare outcomes of Immediate Sequential Bilateral Cataract Surgeries (ISBCS) performed by resident doctors versus consultant ophthalmologists at Moorfields Eye Hospital and its satellite centres.

Methods: The study reviewed ISBCS performed by phacoemulsification and intraocular lens implant, comparing resident ophthalmologists (Gr1) and consultant ophthalmologists (Gr2). Outcomes examined included complications, refraction (spherical equivalent (SE) > 0.5D and >1.0D from predicted target refraction), and uncorrected distance visual acuity (UDVA logMAR) at three months post-ISBCS.

Results: The study included 553 eyes in Gr1 and 687 in Gr2. UDVA post-surgery was similar in both groups (P = 0.26). Intra- and postoperative complications were comparable between groups [RR = 1.88 (95% CI 0.8; 4.2) P = 0.13]. We found no statistically significant difference in refractive outcomes between groups (Gr1 [-0.12 D (IQR -0.5; -0.25)] and Gr2 [-0.25D (IQR -0.63; -0.13)] (P = 0.08)). Similarly, no difference was found in patients with >1.0D SE predicted refractive outcome between groups (6% of Gr1 and 3.9% of Gr2 (P = 0.142)). The grade of the surgeon, PCR risk, and predicted refraction were not significant predictors of postoperative refractive error (SE > 0.5D).

Conclusions: ISBCS outcomes by resident ophthalmologists were comparable to those by consultants. Given the broader fiscal and workforce challenges, our findings advocate that resident ophthalmologists performing ISBCS under supervision may enhance training opportunities.