Resident-Performed Laser-Assisted vs Manual Traditional Phacoemulsification Cataract Surgery

Overview

The study design will be a prospective study comparing laser-assisted cataract extraction cases and traditional manual phacoemulsification cases. All cases will be performed by faculty-supervised residents at Parkland Memorial Hospital. This study aims to examine visual acuity and complication rates in femtosecond laser-assisted cataract surgery compared to traditional manual phacoemulsification cataract surgery for the beginning surgeon. In addition, this study will assess the subjective novice surgeon experience and the patient experience in terms of expectations and results.

The study design will be a prospective study comparing laser-assisted cataract extraction cases and traditional manual phacoemulsification cases. All cases will be performed by faculty-supervised residents at Parkland Memorial Hospital. Cataract surgery training is a standard requirement of all ophthalmology residents who are part of this clinical study. Each resident must be a post graduate year 4 (PGY-4) level resident before being asked to be a part of this clinical study. Typically, each resident will have completed approximately 30 cataract surgeries by their PGY-3 residency year of training. These traditional phacoemulsification require manual capsulorrhexis creation with which residents will have experience prior to study participation. Other critical manual surgical steps of traditional and femtosecond-laser assisted cataract surgery require similar surgical skill sets, thus residents should have surgical skills applicable to both techniques prior to study involvement. In addition to performing 30 traditional phacoemulsification surgeries, residents also will have assisted with femtosecond laser-assisted cases during their PGY-3 training year training at the Dallas VA medical center and with staff at University of Texas (UT) Southwestern Medical Center during their cornea rotation. The femtosecond-assisted cases completed by each resident in the study at Parkland will be the Alcon Certification cases for each resident. Performing femtosecond-laser assisted cases at this level of training will provide objective insights into this new surgical technique in resident hands. Patients will not be subjected to any additional risk due to participation in this study as femtosecond laser Alcon Certification is already being performed by residents as part of their standard UT Southwestern ophthalmology training. Patient eyes that meet the inclusion and exclusion criteria below will be randomly assigned to either the laser-assisted or the standard manual phacoemulsification group based. Following surgery, patients will return for post-operative visits at post-op day 1, post-op week 1, post-op month 1, and post-op month 3. Subjects will be followed in the Parkland Surgery Chief clinic. Subjects will not necessarily see the same study surgeon during each post-operative visit period. It should be noted this is the standard procedure as currently practiced in the Parkland ophthalmology clinic. Verification of subject adherence to the post-operative follow-up visit schedule will be overseen by the PI throughout the course of the project. Weekly communication with sub-investigators will take place in order to review any outstanding concerns including recruitment effort, surgery schedules, and post-operative visit timelines. Arrangements for additional visits will also be reviewed and scheduled if medically necessary depending on individual patients' post-operative clinical course. Patients will be assigned to each group during the period of September 2015 through July 2016 and followed as part of the study for 3 months post-operatively. Patients will be offered the same kerato-refractive procedures including manual limbal relaxing incisions or LenSx astigmatic keratotomy that would be offered to patients who are not part of this study. Patients will also be evaluated for benefit from advanced technology intraocular lenses (Toric for astigmatism and ReStor multifocal) that patients who are not part of the study would be offered. Offering advanced technology lenses or combined kerato-refractive procedures is not expected to influence the visual acuity study outcomes for patients in this study. Patient's clinical history, past medical history and ophthalmic medical notes (in particular pre-operative evaluation, operative, and post-operative follow up) will be reviewed. De-identified data points will be extracted for this project.