title: Outcomes of cataract surgery with residents as primary surgeons in the Veterans Affairs Healthcare System.
abstract: OBJECTIVE
  To explore visual outcomes, functional visual improvement, and events in resident-operated cataract surgery cases.
  
  
  METHODS
  Veterans Affairs Ophthalmic Surgery Outcomes Database Project across 5 Veterans Affairs Medical Centers.
  
  
  METHODS
  Retrospective data analysis of deidentified data.
  
  
  METHODS
  Cataract surgery cases with residents as primary surgeons were analyzed for logMAR corrected distance visual acuity (CDVA) and vision-related quality of life (VRQL) measured by the modified National Eye Institute Vision Function Questionnaire and 30 intraoperative and postoperative events. In some analyses, cases without events (Group A) were compared with cases with events (Group B).
  
  
  RESULTS
  The study included 4221 cataract surgery cases. Preoperative to postoperative CDVA improved significantly in both groups (P < .0001), although the level of improvement was less in Group B (P = .03). A CDVA of 20/40 or better was achieved in 96.64% in Group A and 88.25% in Group B (P < .0001); however, Group B had a higher prevalence of preoperative ocular comorbidities (P < .0001). Cases with 1 or more events were associated with a higher likelihood of a postoperative CDVA worse than 20/40 (odds ratio, 3.82; 95% confidence interval, 2.92-5.05; P < .0001) than those who did not experience an event. Both groups had a significant increase in VRQL from preoperative levels (both P < .0001); however, the level of preoperative to postoperative VRQL improvement was significantly less in Group B (P < .0001).
  
  
  CONCLUSIONS
  Resident-operated cases with and without events had an overall significant improvement in visual acuity and visual function compared with preoperatively, although this improvement was less marked in those that had an event.
  
  
  BACKGROUND
  None of the authors has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Ophthalmology Department (Payal, Gonzalez-Gonzalez, Chen, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, the Department of Ophthalmology (Daly), Boston University School of Medicine, and the Department of Ophthalmology (Payal, Chen, Daly), Harvard Medical School, Boston, Massachusetts; the Veteran Affairs Tennessee Valley Healthcare System Center and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Michael E. DeBakey Veteran Affairs Medical Center and the Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; the Ophthalmology Department, St. Louis Veteran Affairs Medical Center and the Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA.
authors.forename: Abhishek R
authors.initials: AR
authors.lastname: Payal
authors.affiliation: From the Ophthalmology Department (Payal, Gonzalez-Gonzalez, Chen, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, the Department of Ophthalmology (Daly), Boston University School of Medicine, and the Department of Ophthalmology (Payal, Chen, Daly), Harvard Medical School, Boston, Massachusetts; the Veteran Affairs Tennessee Valley Healthcare System Center and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Michael E. DeBakey Veteran Affairs Medical Center and the Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; the Ophthalmology Department, St. Louis Veteran Affairs Medical Center and the Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Gonzalez-Gonzalez
authors.affiliation: From the Ophthalmology Department (Payal, Gonzalez-Gonzalez, Chen, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, the Department of Ophthalmology (Daly), Boston University School of Medicine, and the Department of Ophthalmology (Payal, Chen, Daly), Harvard Medical School, Boston, Massachusetts; the Veteran Affairs Tennessee Valley Healthcare System Center and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Michael E. DeBakey Veteran Affairs Medical Center and the Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; the Ophthalmology Department, St. Louis Veteran Affairs Medical Center and the Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA.
authors.forename: Xi
authors.initials: X
authors.lastname: Chen
authors.affiliation: From the Ophthalmology Department (Payal, Gonzalez-Gonzalez, Chen, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, the Department of Ophthalmology (Daly), Boston University School of Medicine, and the Department of Ophthalmology (Payal, Chen, Daly), Harvard Medical School, Boston, Massachusetts; the Veteran Affairs Tennessee Valley Healthcare System Center and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Michael E. DeBakey Veteran Affairs Medical Center and the Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; the Ophthalmology Department, St. Louis Veteran Affairs Medical Center and the Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA.
authors.forename: Tulay
authors.initials: T
authors.lastname: Cakiner-Egilmez
authors.affiliation: From the Ophthalmology Department (Payal, Gonzalez-Gonzalez, Chen, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, the Department of Ophthalmology (Daly), Boston University School of Medicine, and the Department of Ophthalmology (Payal, Chen, Daly), Harvard Medical School, Boston, Massachusetts; the Veteran Affairs Tennessee Valley Healthcare System Center and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Michael E. DeBakey Veteran Affairs Medical Center and the Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; the Ophthalmology Department, St. Louis Veteran Affairs Medical Center and the Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Chomsky
authors.affiliation: From the Ophthalmology Department (Payal, Gonzalez-Gonzalez, Chen, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, the Department of Ophthalmology (Daly), Boston University School of Medicine, and the Department of Ophthalmology (Payal, Chen, Daly), Harvard Medical School, Boston, Massachusetts; the Veteran Affairs Tennessee Valley Healthcare System Center and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Michael E. DeBakey Veteran Affairs Medical Center and the Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; the Ophthalmology Department, St. Louis Veteran Affairs Medical Center and the Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Baze
authors.affiliation: From the Ophthalmology Department (Payal, Gonzalez-Gonzalez, Chen, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, the Department of Ophthalmology (Daly), Boston University School of Medicine, and the Department of Ophthalmology (Payal, Chen, Daly), Harvard Medical School, Boston, Massachusetts; the Veteran Affairs Tennessee Valley Healthcare System Center and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Michael E. DeBakey Veteran Affairs Medical Center and the Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; the Ophthalmology Department, St. Louis Veteran Affairs Medical Center and the Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA.
authors.forename: David
authors.initials: D
authors.lastname: Vollman
authors.affiliation: From the Ophthalmology Department (Payal, Gonzalez-Gonzalez, Chen, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, the Department of Ophthalmology (Daly), Boston University School of Medicine, and the Department of Ophthalmology (Payal, Chen, Daly), Harvard Medical School, Boston, Massachusetts; the Veteran Affairs Tennessee Valley Healthcare System Center and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Michael E. DeBakey Veteran Affairs Medical Center and the Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; the Ophthalmology Department, St. Louis Veteran Affairs Medical Center and the Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA.
authors.forename: Mary G
authors.initials: MG
authors.lastname: Lawrence
authors.affiliation: From the Ophthalmology Department (Payal, Gonzalez-Gonzalez, Chen, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, the Department of Ophthalmology (Daly), Boston University School of Medicine, and the Department of Ophthalmology (Payal, Chen, Daly), Harvard Medical School, Boston, Massachusetts; the Veteran Affairs Tennessee Valley Healthcare System Center and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Michael E. DeBakey Veteran Affairs Medical Center and the Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; the Ophthalmology Department, St. Louis Veteran Affairs Medical Center and the Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA. Electronic address: mary.daly2@va.gov.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Daly
mesh_terms: D002983:Clinical Competence; D006801:Humans; D007396:Internship and Residency; D007431:Intraoperative Complications; D000072163:Ophthalmologists / Q000193:education*; D017063:Outcome Assessment, Health Care; D018918:Phacoemulsification / Q000592:standards*; D011183:Postoperative Complications; D011787:Quality of Health Care / Q000592:standards*; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health; D014792:Visual Acuity / Q000502:physiology*