The power of audit: Changing intraocular lens preference among RANZCO surgeons

Deepaysh D. D. C. S. Dutt, Josephine Richards, Philip House

Meeting:  2022 RANZCO


Date:      -

Session Title: FREE PAPERS – CPD Audits

Session Time:      -

Background: Participants in the 2016 RANZCO Collaborative Glistenings Audit reported glistenings most commonly in AlconAcrysof intraocular lenses (IOL) despite manufacturing improvements, with yellow chromophore a possible risk factor. A follow-up two surgeon audit of the AlconAcrysof material confirmed that glistenings were more common and of higher grade in chromophore containing IOLs. A prospective 19 surgeon study in 2019 showed a change in preference from chromophore to non-chromophore IOLs. The effect of previous audit participation on current clinical practice in IOL selection formed the topic of this audit in 2021.

Benchmarking/Standard: Surgeon preference for long- term optical performance including freedom from glistenings.

Methods: A four-item online questionnaire was sent to all 28 2016 Audit participants. Questions addressed participants’ prior and current chromophore preference, reasons for this and sources of information influencing preference.
Results: Fifteen clinicians (54%) responded to the sur- vey. Of these, 53% (n = 8) preferred chromophore lenses prior to the 2016 Audit participation, dropping to 33% (n = 5) after participation. Clear lens preference grew from 27% (n = 4) to 40% (n = 6). Undecided surgeons changed marginally (20%, n = 3 to 27%, n = 4).
Four clinicians preferred non-chromophore lenses with concerns that chromophore may increase the risk of glistenings. Participation in the 2016 audit had informed the preference of 60% (n = 9) of clinicians, as did reflection on personal experience (75%, n = 12) and related publications (47%, n = 7).

Recommendations: There are various factors that impact on clinician IOL preference. Importantly, this includes involvement in clinical audits. Audit participation with reflection should be encouraged as it can positively impact clinical practice.