Practice patterns across Europe

EUREQUO finds younger patients, better cataract outcomes over past decade

Howard Larkin

Posted: Tuesday, September 1, 2020

Over the decade ending in 2017, European cataract patients on average grew younger, had better preoperative visual acuity, and better visual and refractive outcomes with fewer complications, according to a study based on data from the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). Use of topical anaesthesia and hydrophobic acrylic intraocular lenses also increased, Sonia Manning MD told a session of the 37th Congress of the ESCRS in Paris in September 2019.

Based on records from 2,714,108 cataract cases performed in 17 European countries from 2008 through 2017, the study found that mean age at surgery decreased continuously year-over-year from 74.5 years to 73.0. Mean preoperative visual acuity also improved from 0.46 log MAR to 0.37 log MAR, or from about 20/60 to about 20/45. The percentage of patients without ocular co-morbidities also increased from 70.0% to 73.0%, which is consistent with a decline in the percentage of anticipated difficult surgeries from 12.6% to 10.6%.


Based on records from 1,522,576 surgeries, use of topical anaesthesia skyrocketed from 28.1% in 2008 and then levelled off at just over 70% in 2015 to 2017. At the same time retrobulbar anaesthesia dropped from 24.7% to under 10% in 2013 to 2017. Subtenon, intracameral and peribulbar anaesthesia also dropped continuously while general anaesthesia use remained steady at about 2.5% of cases.

Phacoemulsification remained by far the most popular cataract extraction choice, holding steady at about 99% of cases in Europe for the entire period. Acrylic hydrophobic lenses gained, moving from about 79% in 2008 to about 90% in 2015 to 2017. Hydrophilic acrylic dropped from about 14% to about 10% while silicone lenses fell from 5.8% to zero in 2015. The use of multifocal and toric IOLs was low in this database, Dr Manning reported.

Based on records from 1,129,944 cases, capsule complications dropped from 1.44% to 0.66%. Iris damage and dropped nuclei were low and dropped by about half.

Postoperative complications varied considerably year to year but ended the study period where they started at 1.88%. Central corneal oedema was most common and increased, followed by uveitis, uncontrolled intraocular pressure and endophthalmitis.

The percentage of patients within 0.5 dioptre of target refraction rose steadily from 66.9% to 73.4%, while those within 1.0 dioptre increased from 89.6% to 93.6%. Patients reaching post-op corrected-distance visual acuity of at least 0.0 log MAR, or 20/20, jumped from 58.3% to 75%.

Dr Manning ended up by thanking all surgeons contributing to the EUREQUO database.

Sonia Manning: