PURPOSE: To determine the practice variation in rate of Nd:YAG laser capsulotomy within one year after cataract surgery and to identify possible associations with physician practice styles.
SETTING: All hospitals and private clinics in The Netherlands.
DESIGN: Retrospective observational study.
METHODS: In the national medical claims database, we identified all laser capsulotomies performed in the Netherlands within a year after cataract surgery in the years 2016 and 2017. Centres with the lowest and highest percentages of Nd:YAG laser capsulotomies were interviewed on their physician practice styles related to the development of posterior capsule opacification.
RESULTS: The incidence of Nd:YAG laser capsulotomy varied between 1.2% and 26.0% in 2016 (median 5.0%) and between 0.9% and 22.7% in 2017 (median 5.0%). The rate of capsulotomy was highly consistent over time for each centre (Pearson correlation coefficient, 0.89, P < 0.001). In general, ophthalmology centres with a high rate of Nd:YAG laser capsulotomy more often did not (routinely) polish the posterior lens capsule, performed cortex removal with coaxial irrigation/aspiration (instead of bimanual), and more often used hydrophilic IOLs (compared to only using hydrophobic IOLs).
CONCLUSIONS: We found a significant practice variation in performing Nd:YAG laser capsulotomy within one year after cataract surgery in the Netherlands. Routinely polishing the posterior capsule, using bimanual I/A, and the use of hydrophobic IOLs are associated with a lower incidence in Nd:YAG laser capsulotomy. Incorporating these practice styles may lower the practice variation and thus prevent added medical burden for the patient and decrease costs.
|Journal||Journal of Cataract and Refractive Surgery|
|Publication status||E-pub ahead of print - 21 Dec 2022|