Posters

Trainee experience with capsular tension rings in Scotland – the need for structured simulation exposure to surgical adjuncts

Poster Details

First Author: C.Mulholland UK

Co Author(s):    C. Mulholland   D. Lockington                 

Abstract Details

Purpose:

Capsular tension rings (CTRs) help maintain capsular integrity and redistribute tension in the setting of zonular weakness during cataract surgery. Although their planned use can be decided pre-operatively, they may be required with changing intra-operative complexities. Publications suggest 1% of cataract operations will require a CTR. As approximately 42000 cataract operations are performed yearly within NHS Scotland, it follows that ophthalmic trainees should be aware of the indications for CTR use, and familiar with the relevant insertion techniques involved. We therefore aimed to evaluate exposure and experience with CTR use within Scottish residency programmes

Setting:

Online survey of Scottish trainees experience with CTRs, coordinated from Tennent Institute of Ophthalmology, Glasgow, Scotland.

Methods:

In the UK, an ophthalmic trainee is deemed competent at a consultant level following completion of 350 cataract operations. Concern has previously been raised regarding the exposure and experience of managing surgical complications by senior trainees. In light of this, we distributed an online questionnaire (surveymonkey.com) amongst ophthalmic trainees in each respective Scottish deanery (North, East, South-East and West). Questions established respondents’ previous surgical experience with phacoemulsification and subsequently focused on observation and use of CTRs including any prior formal training.

Results:

Thirty responses were obtained (45% response rate). 14 (47%) performed less than 50 phacoemulsification procedures; 8 (27%) performed greater than 350. Most (90%) correctly stated zonular weakness as primary indication for CTR use. Only one (3%) had received formal CTR training. Six (30%) had never observed CTR insertion and 23 (77%) had never used one. All CTR use was by senior trainees and of the 8 with greater than 350 cataract operations, 2 had never used a CTR and 3 had only ever used it once. Four of these 5 also had not observed CTR use in the previous year.

Conclusions:

Scottish trainees’ experience with CTRs is variable, with minimal formal simulated training and low clinical exposure. Five of the 8 senior respondents who had achieved the 350 mandatory cataract operations to be deemed an independent cataract surgeon in the UK system had minimal or no experience with CTRs. We would suggest use of predictable surgical adjuncts in complex cataract surgeries should be a specific competency to be achieved. There may be similar experience gaps in ophthalmic surgical training in other countries. Providing simulated scenario exposure to predictable surgical adjuncts should improve confidence and surgical outcomes in complex cases.

Financial Disclosure:

None