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• W4239496871 abstract "We thank Tuuminen et al for acknowledging the merits of our article on case mix in cataract procedures and its relation to surgery volumes. As demonstrated in our study, low preoperative visual acuity is indeed a strong risk factor for capsule complication; an adjusted odds ratio of 1.82 was seen for patients with a best-corrected visual acuity of ≤0.1 (decimal) before surgery. From that perspective, postponing surgery—a probable consequence in countries where cut-off values of best-corrected visual acuity are being used for publicly reimbursed cataract surgery—may result in increased rate of complications. However, previous studies from the Swedish National Cataract Register have demonstrated that low preoperative best-corrected visual acuity is associated with high postoperative patient satisfaction, whereas one of the most common reasons for poor patient-reported outcome is good preoperative self-assessed visual function.1Mollazadegan K. Lundstrom M. A study of the correlation between patient-reported outcomes and clinical outcomes after cataract surgery in ophthalmic clinics.Acta Ophthalmol. 2015; 93: 293-298Crossref PubMed Scopus (28) Google Scholar,2Ronbeck M. Lundstrom M. Kugelberg M. Study of possible predictors associated with self-assessed visual function after cataract surgery.Ophthalmology. 2011; 118: 1732-1738Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar Clearly, performing cataract surgery on patients with only a minor degree of visual impairment is not advisable and is associated with a high risk of patient dissatisfaction. Also, visual-related problems other than visual acuity should be taken into account, such as glare, decreased contrast sensitivity, and so on. The preferred strategy is to combine these entities into an instrument that can be used for preoperative indication assessment. In Sweden, the NIKE (Nationell Indikationsmodell för KataraktExtraktion) questionnaire, is widely used and has been shown to decrease waiting times for those in greatest need of surgery.3Ng J.Q. Lundstrom M. Impact of a national system for waitlist prioritization: the experience with NIKE and cataract surgery in Sweden.Acta Ophthalmol. 2014; 92: 378-381Crossref PubMed Scopus (8) Google Scholar We agree with Tuuminen et al that the shift in more cataract procedures being performed by private clinics and the increase in high-volume surgeons seen during the last decade in Sweden is interesting.4Zetterberg M. Montan P. Kugelberg M. et al.Cataract surgery volumes and complications per surgeon and clinical unit: data from the Swedish National Cataract Register 2007 to 2016.Ophthalmology. 2020; 127: 305-314Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar The impact of clinical setting on surgery volume, case mix and rate of complications is currently being analyzed on National Cataract Register data. Ambulatory surgery centers, as mentioned by Tuuminen et al, are indeed interesting in this context, providing high patient throughput and greater convenience for patients and surgeons. The marked shift observed in the United States from 2001 to 2014 with a greater proportion of the procedures now being performed in ambulatory service centers as opposed to regular hospital outpatient departments5Stagg B.C. Talwar N. Mattox C. et al.Trends in use of ambulatory surgery centers for cataract surgery in the United States, 2001-2014.JAMA Ophthalmol. 2018; 136: 53-60Crossref PubMed Scopus (20) Google Scholar may well be a parallel phenomenon to the transition in clinical setting for cataract surgery in recent years in Sweden. Re: Zetterberg et al.: A composite risk score for capsule complications based on data from the Swedish National Cataract Register: relation to surgery volumes (Ophthalmology. 2020 Jul 22 [Epub ahead of print])OphthalmologyVol. 128Issue 2PreviewWe read the article by Zetterberg et al1 in which the authors investigated the association between the risk of capsule complications in cataract surgery and patient demographics, ocular comorbidity and intraoperative difficulties. The study analyzed the case mix, determined the odds ratios (ORs) for capsule complications, and created the composite risk scores from adjusted ORs of preoperative and intraoperative risk factors based on the outcomes of 118 534 cataract surgeries conducted in 2016 and coded in the Swedish National Cataract Register. Full-Text PDF" @default.
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• W4239496871 date "2021-02-01" @default.
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• W4239496871 doi "https://doi.org/10.1016/j.ophtha.2020.09.004" @default.
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