Nd:YAG Laser Capsulotomy Rates in the Netherlands; Practice Variation and Association with Physician Practice Styles

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.