Refractive management of patients undergoing cataract surgery. The development of pre and post-operative refractive management guidelines for patients undergoing cataract surgery in the UK

Abstract

Cataract surgery is the most commonly performed surgery within the UK with 400,000 surgeries performed each year. Currently no guidelines exist for clinicians regarding target refraction discussions, spectacle provision post-operatively and driving advice following surgery. The PhD aimed to start the process of developing pre- and post-operative management guidelines for patients developed by both optometrists and ophthalmologists which could then be disseminated to both professions in the hope of improving the overall outcome of surgery. The current literature highlighted target refraction discussions were lacking or non-existent which left some myopes dissatisfied after surgery due to an emmetropic target refraction leaving them unable to read without glasses as they did prior to surgery. Target refraction discussions were found to be linked with years of experience and this needs further exposure in continuing professional development. Post-operative driving advice was found to be inconsistent and vary between practitioners and between optometry and ophthalmology. Advice was found to vary from driving “immediately” following surgery up to 6 weeks post-operatively. Re-analysis of (de Juan et al. 2013) data during our systematic review and meta-analysis found refraction to be stable 1-2 weeks following surgery for 93% of patients. It was found a large change between pre- and post-surgery cylindrical power/axis may be an indicator that refractive stability has not occurred. Although this study had limitations it confirmed refraction is stable sooner than the current guidelines of 4-6 weeks. Finally, we used a Delphi process to develop refractive management guidelines with a total of fifteen recommendations finalised.