AA

1. ARTICLE
Optimizing number of postoperative visits
after cataract surgery: Safety perspective
Inger Westborg, MD, Eva M€
onestam, MD, PhD
Purpose: To evaluate safety perspectives when the standard
routine after cataract surgery is no planned postoperative visit.
Setting: Eye Clinic, Sunderby Hospital, Luleå, Norrbotten County,
Sweden.
Design: Prospective case series.
Methods: All cataract surgery cases during a 1-year period
were included. The study group had the standard routine at the
clinic, that is, no planned postoperative visit for patients without
comorbidity and uneventful surgery. For the control group,
patients who had surgery during 1 month of the 1-year period
were chosen. All these patients had a planned postoperative
visit. All surgeons involved were experienced. The outcome
measures were any planned postoperative visit, any complication
and/or adverse event, postoperative corrected distance visual
acuity (CDVA), and any postoperative control/contact initiated
by the patient.
Results: The study comprised 1249 patients (1115 in the study
group and 134 in the control group). No significant differences in de-
mographics, postoperative CDVA, frequency of planned visits
because of ocular comorbidity, or postoperative patient-initiated
contacts were found between the 2 groups. Of the 1249 patients,
9% (117 patients) initiated a postoperative contact, of whom 26%
(30 patients) also had a scheduled visit. The reasons for the
patient-initiated contacts were visual disturbance, redness and/or
chafing, pain, and anxiety. An evaluation of all medical records
2 years postoperatively found no reports of missed adverse events.
Conclusions: It was possible to refrain from planned postopera-
tive visits for patients having uncomplicated cataract surgery. How-
ever, preoperatively, patients with comorbidities should be
provided with individual planning of their postoperative follow-up.
Preoperative counseling is important, and the clinic must have
resources to answer questions from patients and be prepared for
additional unplanned postoperative visits.
J Cataract Refract Surg 2017; 43:1184–1189 Q 2017 ASCRS and ESCRS
C
ataract surgery is one of the most commonly per-
formed elective surgical procedures in Europe and
the United States.1,A
In Sweden, more than
116 000 surgeries were performed in 2015, of which 43%
were second-eye surgeries.2
As a consequence of the large
number of surgeries performed worldwide, postoperative
visits are a large workload for surgical units. It is important
that all parts of the cataract surgery procedure are appro-
priate and cost-effective.
The timing and number of postoperative visits have been
debated for as long as cataract surgery has been performed.
There are studies of the timing of the postoperative visit,
which has varied from the surgical day to 10 to 14 days post-
operatively.3,4
To our knowledge, no published study has
evaluated the safety perspectives when the number of post-
operative visits are reduced to no planned visit. For routine
cases without comorbidity, 1 to 2 postoperative visits have
been most common in Sweden since the introduction of
phacoemulsification.5
At the Sunderby Hospital Eye Clinic,
Luleå, Sweden, the standard postoperative routine was 1
visit, varying from the surgical day to 10 to 14 days after sur-
gery, depending on the distance the patient had to travel to
the clinic. Patients who had to travel long distances were as-
sessed on the surgical day if an evaluation was considered
necessary. For many years, the clinical experience was that
most postoperative visits were uneventful, with no signs of
complications or need for intervention. Therefore, a new
standard routine after cataract surgery was proposed, that
is, no planned postoperative visits if the surgery was un-
eventful and there were no significant ocular comorbidities.
The purpose of the present study was to evaluate the
safety perspectives when the standard routine after cataract
Submitted: January 9, 2017 | Final revision submitted: June 27, 2017 | Accepted: June 30, 2017
From the Department of Clinical Sciences/Ophthalmology, Faculty of Medicine, Umeå University, Umeå, Sweden.
Presented in part at the European Association for Vision and Eye Research, Nice, France, September 2013.
Supported by grants from Norrbotten County Council Research Fund, Luleå, and from the V€
asterbotten County Council Research Fund, Umeå, and the Swedish Gov-
ernment (Agreement Concerning Research and Education of Doctors [ALF]), the Swedish Medical Society and Capio Medocular, Stockholm, Sweden. The sponsor
and funding organizations had no role in the design or conduct of this research.
Corresponding author: Inger Westborg, MD, Department of Clinical Sciences/Ophthalmology, Faculty of Medicine, Umeå University, S-901 85 Umeå, Sweden. E-mail:
inger.westborg@telia.com.
Q 2017 ASCRS and ESCRS
Published by Elsevier Inc.
0886-3350/$ - see frontmatter
http://dx.doi.org/10.1016/j.jcrs.2017.06.042
1184

2. surgery was changed to no planned postoperative visit in
patients with no significant ocular comorbidities and/or
surgical complications.
PATIENTS AND METHODS
Study Population
All patients having cataract surgery at Sunderby Hospital, Luleå,
Sweden, during a 1-year period (June 1, 2010, to May 31, 2011)
were prospectively registered. The admitting area represents
1.8% of the Swedish population and is sparsely populated, with
many patients having to travel long distances. There are no private
surgical clinics in the area. All patients provided informed consent,
and the study complied with the tenets of the Declaration of Hel-
sinki and was approved by the local ethics committee of Umeå
University.
Patients who had cataract surgery combined with other surgical
procedures were excluded. The study included age-related cataract
surgery cases. Bilateral phacoemulsification was performed on the
same day on patients who were considered as having 1 surgical
event (ie, first-eye surgery). The postoperative data were collected
from the records, which are computerized and standardized at the
clinic.
The study group included all patients following the clinic’s stan-
dard procedure, which is no planned postoperative visit if the eye
has no ocular comorbidity. The most common reasons for plan-
ning a postoperative appointment were glaucoma, wet age-
related macular degeneration (AMD) and/or diabetic retinopathy
(DR) (Table 1). Patients with surgical complications were also
scheduled for a postoperative visit.
The control group included all patients having surgery during
1 month (March) of the 1-year period. All these patients had a
planned postoperative visit, even if there were no ocular comor-
bidities or surgical complications.
Preoperative Evaluation
At Sunderby Hospital, patients are examined and scheduled for
cataract surgery by the admitting ophthalmologist who some-
times, but not always, is a cataract surgeon. The admitting physi-
cian evaluates whether a comorbidity is present and whether a
postoperative visit will be necessary, and in these cases, the appro-
priate timing and care required. At this time, it is also determined
whether the postoperative visit will be with the surgeon or with the
physician/team treating the comorbidity. The same preoperative
evaluation was used for the study group and the control group.
Glaucoma patients who had considerable risk for harmful
postoperative pressure spikes were preoperatively planned for an
intraocular pressure (IOP) measurement 1 day postoperatively
by an ophthalmic nurse. All patients who had DR and patients
who had retinal vein occlusions that might require postoperative
treatment had a planned postoperative visit with an ophthalmic
nurse for retinal photography or with a medical retina specialist
for evaluation if further treatment with laser and/or antivascular
endothelial growth factor was required.
Each patient with AMD was assessed regarding type and risk for
worsening of AMD after cataract surgery and was planned for
postoperative visits accordingly.
Standard Surgical Technique
The dilating drops including instructions are mailed to the pa-
tients and most administer their drops at home as follows: phen-
ylephrine 2.5% and cyclopentolate 1.0%, 1 drop, 3 times in each
eye, 15 minutes apart, starting 1 hour before leaving their homes.
On arrival at the clinic, the admitting nurse checks the patient’s
identity and administers additional mydriatic drops if the pupil
is determined to be too small. The nurse also asks the patient
whether he or she feels calm and relaxed. If the patient shows signs
of anxiety or distress, preoperative sedation is offered. Patients
who require sedation (!1.0%) are given midazolam hydrochlo-
ride sublingually on arrival at the operating room. The dose is
based on the patient’s age and body weight; most receive 2 to 3 mg.
One drop of preservative-free amethocaine hydrochloride
(1.0%) is given before rinsing the eye with chlorhexidine solution
(0.5 mg/mL). In the operating room, a few minutes later, another
drop of amethocaine hydrochloride (1.0%) is administered by
the assisting nurse before the skin is cleaned and the eye draped.
Disinfection and draping to ensure sterility of the surgical field
was established according to standard clinical practice at Sunderby
Hospital.
A small dose (0.2 mL) of preservative-free lidocaine hydrochlo-
ride 1.0% (10 mg/mL) is administered intracamerally by the surgeon
at the beginning of the surgery. If the patient experiences pain or
discomfort during the surgical procedure, additional anestheticsd
amethocaine hydrochloride (1.0%) drops and/or additional intra-
cameral lidocaine hydrochloride (1.0%)dare administered. At the
time of the study, the standard cataract surgery was to create a clear
corneal small incision (2.75 mm) using phacoemulsification and
implant a foldable intraocular lens (IOL). At the end of surgery,
1 mg cefuroxime (Zinacef 1 mg/0.1 mL) was injected intracamerally.
No other topical antibiotics were used. Six experienced consultants
performed all surgeries.
Table 1. Frequency of ocular comorbidities and planned postoperative visits in both groups.
Ocular Comorbidity All Patients (n)
Planned Visits, n (%)
P Value
Study Group Control Group*
AMD 199 79/180 (44) 8/19 (42) .88
Diabetes mellitus 68 44/63 (70) 2/5 (40) .17
Glaucoma 229 165/202 (82) 23/27 (85) .66
Corneal problems 19 4/14 (28) 2/5 (40) .66
Retinal vein occlusions 13 3/10 (30) 2/3 (66) .25
Previous RD 7 2/4 (50) 3/3 (100) .15
Uveitis 3 3/3 (100) 0 d
Strabismus 10 4/6 (66) 2/4 (50) .60
Total number of patients with comorbidity 548 307/482 (64) 42/66 (64) .99
Patients with no comorbidity 701 114/633 (18) 13/68 (19) .82
Total number of planned visits d 421 (38) 55 (41) .46
Visit planned only because patient is in control group d d 79 (60) d
Total number of postoperative visits 1249 421 (38) 134 (100) d
AMD Z age-related macular degeneration; RD Z retinal detachment
*The number of visits in the control group column refers to the assessment that a postoperative visit was necessary, according to the type and severity of the
comorbidity
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3. Postoperative Routine
After leaving the clinic on the surgical day, the patients were given
oral and written information on what to expect during the postop-
erative period; in particular, the symptoms of severe complications
such as endophthalmitis, retinal detachments (RD), and so forth,
were emphasized. As mentioned, the postoperative visits were
planned individually depending on type and severity of comorbid-
ities, the preoperative ocular findings, and an estimation of the pa-
tient’s risk for surgical complications. If complications occurred
during surgery, a postoperative visit was scheduled on the day of
surgery, with the timing based on the type of intraoperative
complication. Data were collected from the patients’ records
1 month and 2 years after the cataract surgery.
Outcome Measures
The outcome measures were any planned postoperative visit,
surgical complications and/or adverse events, postoperative cor-
rected distance visual acuity (CDVA), and postoperative control/
contact initiated by the patient. Serious adverse events were defined
as potentially sight-threatening postoperative findings, such as
infections, severe inflammation, untreated high IOP, and signs of
wound leakage. Outcome results, such as postoperative CDVA
and refractive results, were collected from the medical records.
For patients with no postoperative appointments, the results were
obtained from the optician the patient visited after cataract surgery.
Statistical Analysis
The independent-samples t test was used to compare the mean
age. The chi-square test corrected for continuity was used to
analyze the 2 2 tables. The Mann-Whitney U test was used to
check for differences in CDVA (logarithm of the minimum angle
of resolution [logMAR]) between the study group and the control
group. A P value less than 0.05 was considered statistically signif-
icant. Statistical analysis was performed using SPSS for Windows
software (version 20, IBM Corp.).
RESULTS
Demographics and Surgical Outcomes
Of the 1267 patients who were prospectively registered, the
study included 1249 patients having age-related cataract
surgery. Few patients living in the admitting area (18 [1.0%]
of 1267) had their surgeries at another eye clinic during
the period studied. More than 99% of the patients were
white. Bilateral phacoemulsification was performed on
the same day on 13 patients who were considered as having
1 surgical event (ie, first-eye surgery).
The study group comprised 1115 patients and the control
group comprised 134 patients. Table 2 shows the demo-
graphics and surgical complications in the study group and
the control group. There were no differences in age, sex,
first-eye surgery, or general anesthesia between the 2 groups.
Althoughasignificantlyhigherpercentageofcaseswereregis-
tered as complicated surgery in the control group, there were
no statistically significant differences in severe complications;
that is, cases with vitreous loss. The routine for patients with
surgical complications is a planned postoperative visit, and 72
(80%) of 92 of these patients had a postoperative visit sched-
uled. Twenty patients who were classified as having compli-
cated surgery had no planned postoperative visit. These
cases had prolonged surgery because of prolapse of the iris
or difficult cortical cleaning, and the surgeon did not deter-
mine that a postoperative control visit was necessary.
Five hundred forty-eight (44%) of 1249 patients had an
ocular comorbidity registered in the medical records, of
whom the majority had a planned postoperative visit
(Table 1). There was no significant difference in the fre-
quency of planned visits because of ocular comorbidity be-
tween the study group and the control group. One hundred
twenty-seven (18%) of 701 patients with no ocular comor-
bidity had a planned postoperative visit. The main reasons
were other somatic comorbidities, complications during
first-eye surgery, or unknown. In a small percentage of pa-
tients with no comorbidity (87 [12%] of 701), the medical
records contained no information indicating why a postop-
erative visit was planned. The preoperative evaluation was
the same for the study group and the control group; howev-
er, in the control group, a postoperative visit was planned
for all patients. Table 1 shows 79 patients who had a
planned postoperative visit only because they had surgery
during the control month of March. All postoperative visits
were uneventful with no complications detected.
Patients with active or previous wet AMD were postoper-
atively examined by a medical retina specialist. Of the 199
patients with a diagnosis of AMD (dry or wet), 35 (18%)
had not been in contact with the clinic within 12 months
postoperatively. These patients were elderly (mean age
81 years), and most of them had dry AMD.
Of the 229 patients with glaucoma, 188 (82%) were
scheduled for an IOP control 1 day postoperatively by the
admitting physician or had a planned postoperative visit
on the surgical day. A few patients with suspected glaucoma
or ocular hypertension had no surgical-day or 1-day post-
operative visit. Within 12 months postoperatively, all but
1 of these patients had a planned visit for IOP/glaucoma
control with an ophthalmic nurse, an optician, or a general
practitioner. One patient canceled planned visits and did
not have an IOP control until 1 year postoperatively.
Of the 119 patients with other ocular comorbidities, such
as diabetes, dry-eye syndrome, or corneal problems,107
(89%) had a visit 1 day postoperatively, a visit scheduled
later, or CDVA results reported by an optician within
12 months postoperatively. Within 12 months postopera-
tively, 475 (87%) of 548 patients with ocular comorbidities
had an ocular examination as a planned postoperative visit
or as a scheduled visit because of a comorbidity.
Postoperative Controls and Patient-Initiated Additional
Postoperative Contacts/Visits
Only 117 (9%) of 1249 patients initiated a postoperative
contact (telephone or visit to clinic). Of these 117 patients,
30 (26%) already had a planned visit. A slightly higher
percentage of patient-initiated postoperative contacts
occurred in the study group than in the control group;
however, this difference was not statistically significant
(Table 3). Of 117 patients who initiated contact, 79 (68%)
were first-eye surgery patients and 38 (32%) were second-
eye surgery patients.
Table 4 shows the reasons for patient-initiated contacts.
Most of these contacts, which were made by 64 (55%) of
117 patients, resulted in an appointment with an
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4. ophthalmologist. Visual disturbance, most often caused by
transient corneal edema, was the most common reason.
Advice over the telephone, or in a few cases visiting an
ophthalmic nurse, solved the problem for 53 (45%) of the
117 patients. All patients who initiated contact with condi-
tions that required care or medication changes were referred
to an ophthalmologist. No late adverse events were reported
by patients who received telephone advice only.
Six hundred twenty-eight (56%) of the 1115 patients in
the study group had no planned postoperative or otherwise
scheduled review after surgery. An evaluation of all medical
records 2 years after the cataract surgery found no reports
of missed adverse events.
Severe Postoperative Complications
There were no cases of severe postoperative complications,
such as endophthalmitis or severe cases of uveitis in the pre-
sent study. There were 5 cases of postoperative RD. All these
patients were included in the study group; however, there
were no significant differences between them and the patients
in the control group (P Z .44). Preoperatively, 2 of these pa-
tients were diagnosed with high myopia (axial length
25.7 mm and 30.0 mm) and 1 was diagnosed with dry
AMD. All 5 patients initiated contact postoperatively because
of disturbed vision and were examined at the clinic. Four
patients who had uneventful cataract surgery contacted the
clinic after 13 days, 28 days, 40 days, and 45 days, respec-
tively. One case with a complicated surgery because of zonu-
lar rupture had a review 1 day postoperatively and then
contacted the clinic 3 weeks later because of low vision.
DISCUSSION
This study was performed to highlight the postoperative
safety aspects when the standard postoperative routine is
no planned postoperative visit after uneventful cataract sur-
gery in patients without ocular comorbidity. This study did
not evaluate whether patients would prefer to have a post-
operative examination by their surgeon. An unpublished
survey at the clinic that asked whether patients preferred
a postoperative visit with their surgeons at the operating
clinic or a visit at a satellite clinic nearby their homes found
that most patients preferred a visit for which they would
have to travel the shortest distance possible.
We found no statistically significant difference in postop-
erative CDVA and serious postoperative complications be-
tween the patients in the study group and those in the
control group. This suggests that the new routine of no
planned postoperative visits is safe for most patients.
As expected, preoperatively planned postoperative visits
were mainly for patients with an ocular comorbidity. A pre-
operative evaluation of the individual patient and a plan for
a postoperative review are crucial and demand a thorough
preoperative examination. In our study, most patients
(87%) with an ocular comorbidity had a planned postoper-
ative visit or a scheduled visit within 12 months. The
routine for patients with surgical complications is always
a planned postoperative visit.
Preoperative information (oral and written) is important,
and the clinic must have resources to answer questions from
patients and be prepared for additional unplanned postop-
erative visits. A small percentage of the patients (9%)
Table 2. Demographics and surgical complications in both groups.
Variable Study Group Control Group P Value
Cases (n) 1115 134 .08
Mean age (y) 74.0 75.5 d
95% CI 73.4, 74.5 74.0, 77.0 d
Range 22, 96 50, 92 d
Male sex (%) 45 40 .34
Right-eye surgery (%) 53 52 1.0
First-eye surgery (%) 63 67 .37
Cases w/complicated surgery, n (%) 76 (7.0) 16 (12.0) .03*
Cases w/vitreous loss, n (%) 18 (1.6) 1 (0.7) .44
General anesthesia, n (%) 8 (0.7) 1 (0.7) 1.0
CI Z confidence interval
*Statistically significant
Table 3. Frequency of postoperative visits preoperatively planned or planned on the day of surgery, postoperative patient-
initiated contacts, and postoperative CDVA in both groups.
Parameter Study Group (n Z 1115) Control Group (n Z 134) P Value
Planned postop visits, n (%). 421 (38) 134 (100) d
Postop patient-initiated contact, n (%). 105 (9.4) 12 (8.9) .87
Patients w/documented postop CDVA and refraction, n (%) 884 (79) 134 (100) d
Postop CDVA .14
LogMAR
Median 0.10 0.10
Range 0.10, 2.0 0.08, 1.4
Snellen
Median 0.80 0.80
Range 0.0, 1.25 0.0, 1.20
CDVA Z corrected distance visual acuity; logMAR Z logarithm of the minimum angle of resolution
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5. initiated contact by themselves postoperatively. The various
symptoms and problems the patients could, in many cases,
be solved by advice over the telephone or by visiting an
ophthalmic nurse. An ophthalmologist’s care was required
by only 64 patients, which accounted for 55% of all un-
planned contacts. The safety of the new routine is also sup-
ported by no missed adverse events, such as high IOP,
infections, or signs of wound leakage, by any patient without
a planned postoperative visit, according to a review of the
patients’ total medical records including primary healthcare
2 years postoperatively. It is important to have good
communication with primary healthcare providers because
patients in isolated communities tend to visit the closest
healthcare facility. Primary healthcare is well equipped in
the northern part of Sweden, having an ophthalmic micro-
scope and the ability to measure IOP. There are no private
clinics practicing ophthalmic care in the area.
The frequency and timing of postoperative visits after cata-
ract surgery have been debated since the beginning of the
intraocular surgery era. A previous study6
found the interven-
tion rate to be low on the first day after uneventful cataract
surgery; however, that study concluded it was impossible, in
terms of personal and economic resources, to design a routine
for detection of serious postoperative complications before
they were symptomatic. The first-day visit might be with-
drawn for uneventful phacoemulsification surgery and a sin-
gle review 1 to 2 weeks postoperatively, supplemented by
patient-initiated contacts in the interim, has been suggested.7,8
A randomized trial9
also found a low frequency of serious
postoperative complications on the first postoperative day.
For the overall majority of patients, the visual outcome is
not compromised when the routine of first-day postopera-
tive review is omitted after uneventful phacoemulsification
surgery. A retrospective review of 1000 surgical events10
suggested that all patients with any identifiable preoperative
or intraoperative risk should be routinely reviewed 1 week
after surgery. This study was published in 2001, and 4.0%
of all patients and 7.8% of patients with a preoperative or
surgical risk factor had postoperative complications; how-
ever, registrars performed the surgery in 38.0% of the pa-
tients. In our present study, all surgeries were performed
by experienced surgeons. Postoperative visits are important
and necessary as a learning tool and play an important part
in residents or surgeons in training acquiring surgical skills.
A regimen of no planned postoperative visits is valid for
experienced surgeons only.
InaUnitedKingdomnationalsurvey,11
therewerenocom-
plications (perioperatively and/or postoperatively) in more
than 95% ofcases. Our findings are inconcordance with those
in several studies of uneventful cataract surgery, in which
more than 95% of review visits found nothing was achieved
beyond mutual reassurance.12
Some studies4,9
found that
the first review after phacoemulsification cataract surgery
could be safely deferred until 2 weeks postoperatively.
Improved perioperativepatient education with anopen chan-
nel for immediate self-referral should symptomatic problems
develop is important. We believe our routine, which includes
oral and written patient education, is necessary and sufficient.
The most frequent postoperative complications requiring
treatment are IOP spikes. They are thought to be self-
limiting, peaking at approximately 6 hours, and are more
common in glaucoma patients.13,14
Postoperatively elevated
IOPinhealthy eyesdeclinesspontaneouslyandcanbeleftun-
treated if it is not associated with corneal edema or patient
discomfort.Forpatientswithglaucoma,inparticularforthose
who have compromised optic discs, high IOP spikes postop-
eratively can be devastating. These patients benefit from early
postoperative checkups. Glaucoma patients must always have
a follow-up plan. A prophylactic acetazolamide regimen
might reduce the risk for pressure spikes postoperatively
but does not completely eliminate it. An evaluation of IOP
in patients with glaucoma/ocular hypertension 1 day postop-
eratively has been recommended.15
Therefore, in the present
study most patients with glaucoma/ocular hypertension were
scheduled for a first-day postoperative visit and IOP control.
Other postoperative complications that might require
treatment, such as anterior uveitis and corneal abrasions,
are mostly associated with distinct ocular symptoms (pain
and/or reduced vision). In particular, patients with symptoms
related to corneal abrasions often initiate contact and will
most likely have an unplanned postoperative examination.
Visualdisturbancewasthemostfrequentreasonforpatient-
initiated contact in the present study. Transient corneal edema
is a common postoperative complication that might be associ-
ated with IOP elevation or endothelial insufficiency.
In the present study, the frequency of postoperative RD
was high. However, retinal detachment is known to be a
late complication of cataract surgery, and the high incidence
found in the study might be random.11,16,17
The preoperative
evaluations found high myopia in 2 cases, and 1 patient had
complicated surgery; all these patients initiated contact when
they had symptoms of visual disturbance.
Table 4. Reasons for patient-initiated postoperative contact and level of the ophthalmic care assessed necessary.
Reason/Symptom
Number (%)
Patients Physician* Nurse*
Telephone Advice from
Nurse*
Visual disturbance 59 (50) 37 (63) 0 22 (37)
Redness and/or chafing 33 (28) 12 (36) 1 (3) 20 (61)
Pain 16 (14) 11 (69) 1 (6) 4 (25)
Anxiety 9 (8) 3 (33) 0 6 (67)
Total 117 (100) 64 (55) 2 (2) 51 (43)
*Percentages refer to distribution within each group of reason/symptom
1188 POSTOPERATIVE FOLLOW-UP VISIT AFTER CATARACT SURGERY
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6. To improve efficiency in postoperative care, shared care
with ophthalmic nurses and opticians has been suggested
to reduce the demand on physician time.12,18
An educated
ophthalmic nurse first assesses the patients’ problems and
decides who requires attention from an ophthalmologist. The
opticians check the refraction and the CDVA 4 to 6 weeks
after surgery and refer patients to the eye clinic if the CDVA
is lower than expected or if there are other problems. In this
study, patients were recommended to have a postoperative
visit with an optician or an optometrist, although there was
no formal collaboration between our clinic and the other
providers. The CDVA and refraction information for
patients who wanted a second-eye surgery were sent to
the eye clinic for planning the next surgery. The measure-
ments were also provided to patients who requested them
or obtained them from their medical records after visits
or referral to our clinic for other ophthalmic problems.
In conclusion, the increasing number of cataract surgeries
and the consequent increased workload for eye clinics can
be reduced by optimizing postoperative visits. It is possible
to refrain from performing standard postoperative visits af-
ter cataract surgery in patients with uneventful surgery and
no ocular comorbidity without compromising patient
safety. Proper patient education, however, is necessary.
Results in the present study show that no postoperative visit
is necessary in approximately 50% of cataract surgery cases.
The patients can obtain postoperative refraction and CDVA
information from opticians or optometrists.
WHAT WAS KNOWN
The safety aspects regarding the timing of postoperative
follow-up after cataract surgery have been debated. There is
a low risk for postoperative complications, and follow-up
can be deferred up to 2 weeks after cataract surgery.
WHAT THIS PAPER ADDS
From a safety perspective, it is possible to refrain from
planned postoperative visits in uneventful cases with no
comorbidities. Patients with a comorbidity require individual
planning for their postoperative care.
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Disclosure: Neither author has a financial or proprietary interest in
any material or method mentioned.
First author:
Inger Westborg, MD
Department of Clinical Sciences/
Ophthalmology, Faculty of Medicine,
Umeå University, Umeå, Sweden
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POSTOPERATIVE FOLLOW-UP VISIT AFTER CATARACT SURGERY
Volume 43 Issue 9 September 2017