Changing practice patterns in European cataract surgery as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery 2008-2017

Purpose: To study practice patterns in European cataract surgery over a 10-year period. Setting: European clinics affiliated to the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). Design: Registry cohort study. Methods: The EUREQUO contains preoperative, intraoperative, and postoperative parameters reported by surgeons in many European clinics. All data reported to the registry are anonymized. Preoperative parameters included age, sex, visual acuity, target refraction, ocular comorbidity, and surgical difficulties. Surgical data included anaesthesia, surgical technique, intraocular lens optic biomaterial, and complications. Postoperative parameters included visual acuity, refraction, and short-term complications. Results: During the study period (January 1. 2008-December 31, 2017) a total of 2,714,108 cataract extractions were reported to the EUREQUO. Preoperative data changed over time, with decreases in mean age (74.5 to 73.0), proportion of women from 60.6% (100,373/165,628) to 57.2% (174,908/305,845), and proportion of co-existing eye diseases from 30.0% (49,638/165,650) to 27.0% (82,704/305,846); and improvements in preoperative visual acuity (mean logMAR 0.46 to 0.37). The use of topical anaesthesia increased over time from 28.1% (26,238/93,320) to 71.7% (130,525/182,083). Surgical complications showed a significant decrease from 2.5% (4,107/165,650) to 1.2% (3,573/305,846). The visual outcome improved over time (mean logMAR 0.08 to 0.05), as did the absolute median prediction error (0.38 diopter [D] to 0.28 D). Conclusions: Trends in European cataract surgery practice patterns from 2008 to 2017 have moved toward younger patients with better preoperative visual acuity, fewer surgical complications, and better predicted refractions and visual outcomes