ECOS proving to be a useful tool for cataract surgeons in Europe

The use of foldable intraocular lenses (IOLs) in cataract surgery is a trend that is continuing to rise across Europe, according to Mats Lundstrom speaking at the Outcomes of Cataract and Refractive Surgery symposium.

The European Cataract Outcome Study (ECOS) has been running since 1995 and, so far, 88 surgical units from 27 countries have been involved. Each year, for one month, the units involved collect data for every cataract procedure that is performed. This data is entered into a web based form and collated. The aim is to reflect the outcomes of routine medical care, to create a European basis for quality assurance in cataract surgery and to form a system of benchmarking for best practice.

Lundstrom presented the current results which demonstrate the important trends in the industry. In 1998 ECOS started compiling data on surgical complications and, what has become apparent is that the percentage of sight threatening complications has remained steady at around 3%.

In 2005, 3% of complications were due to white cataracts, 3% were down to small pupil size and 2% were corneal opacities. The rate of ocular morbidity currently stands at around 30-40% but this figure is rising. Second eye surgery now accounts for approximately 40% of procedures and appears to be stable at this level.

The percentage of phacoemulsification procedures stands at 98% and the use of foldable IOLs is at 90%, but this is continuing to rise year by year. The number of surgeons using drop anaesthetics is rising and currently stands at around 74%. The number of in-patient procedures is steadily decreasing.

The web database that is created from these statistics enables surgeons to record, audit and compare outcomes. Ypes Henry from The Netherlands, who has been involved in the project for ten years, sees the importance of such information. He spoke of how, since joining the scheme, he has been able to highlight the areas in which his unit could improve. For example, he noticed that the rate of induced astigmatism was high in comparison with some units and after examining the data he changed to using foldable IOLs and the problem has been resolved.

Henry stresses the importance of the anonymity of the database, since the names of the units are not included there is no sense of embarrassment or fear, it simply becomes a process of seeing how your surgical unit compares with the average outcomes and where you might improve or indeed seeing where it is doing well. Henry feels that there is a real sense of getting something in return for your input.

The feeling from the symposium was that ECOS has been a success. It has produced a standardized system of collecting data and is already having a real impact on helping to improve outcomes across Europe.

Ophthalmology Times Europe reporting from the XXIV Congress of the ESCRS, London, 9-13 September, 2006.