Current Trends in Cataract and Refractive Surgery in Japan: 1999 Survey

doi:10.1016/S0021-5155(01)00333-1

Japanese Journal of Ophthalmology

Volume 45, Issue 4, July–August 2001, Pages 383-387

https://doi.org/10.1016/S0021-5155(01)00333-1 Get rights and content

Abstract

Purpose: The eighth annual survey was carried out by mail in February 2000 to investigate the current trends in cataract and refractive surgery in Japan.

Respondents: Questionnaires were sent to 930 ophthalmologist members of the Japanese Society of Cataract and Refractive Surgery. Data received from 457 (49.1%) of the recipients were cross-analyzed and compared with those from the previous surveys.

Results: In cataract surgery, 17% of respondents were doing 51 or more cases per month, 94% preferred phacoemulsification, 58% employed the self-sealing wound closure technique, and 26% used topical anesthesia for phacoemulsification. In refractive surgery, excimer laser surgery and astigmatic keratotomy attracted notably high interest, while less attention was directed toward radial keratotomy and intrastromal corneal ring. Laser in situ keratomileusis, photorefractive keratectomy, phakic intraocular lens, intrastromal corneal ring, and radial keratotomy were judged to be useful refractive surgical procedures by 69.0%, 40.0%, 24.6%, 14.2%, and 8.0% of the respondents, respectively.

Conclusion: There are trends toward more surgical procedures performed by a surgeon, shorter period of hospitalization, and increasing preference for small incision cataract surgery. Refractive surgery is not yet widely performed, but laser in situ keratomileusis is viewed as the most promising procedure.

Introduction

With the evolving surgical techniques and instrumentations, the cataract and refractive surgical procedures are now among the most successful and the most common in medicine. Because the numbers of both surgical procedures and surgeons are growing, a clear understanding of the current situation and future trends in these fields has become increasingly important. In the United States and European countries,1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 surveys have been conducted on the procedural styles and preferences of anterior segment surgeons, giving a detailed view of the trends taking place in those countries. Since 1992, we have conducted annual mail surveys of members of the Japanese Society of Cataract and Refractive Surgery.19, 20, 21 The current study represents the eighth such survey on cataract and refractive surgical practices in Japan.

Section snippets

Materials and Methods

Survey forms with 40 multiple-choice questions were mailed in February 2000 to 930 ophthalmologist members of the Japanese Society of Cataract and Refractive Surgery. To maintain the confidentiality of the respondents, no name was indicated on the return envelopes and questionnaires.

Results

Replies were received from 457 (49.1%) of the recipients prior to the cutoff date of March 31, 2000. We used personal computer database programs (Access 2000; Microsoft, Tokyo, and Statistica™ for Windows, StatSoft, Tulsa, OK, USA) for data analysis. Summaries of representative data follow.

Discussion

Because the respondents in this survey were members of the Japanese Society of Cataract and Refractive Surgery, results may not exactly reflect the opinions of all Japanese ophthalmologists. The sampling population might have represented a group of ophthalmologists who are more active in the field of cataract and refractive surgery. Because of the anonymous nature of the survey, it is not possible to trace the ophthalmologists who did not return the survey to see whether their replies would

Acknowledgements

The authors express their appreciation to the hundreds of surgeons who responded so comprehensively to the request for information. This work was supported by the grant from Japanese Society of Cataract and Refractive Surgery. This paper was originally published in Japanese in Intraocular Lens and Refractive Surgery 2000;14:380–389. It appears here in a modified form with the permission of Intraocular Lens and Refractive Surgery, after peer review and editing for the Japanese Journal of

References (21)

D.N. Campbell et al.
A national survey of the use of local anaesthesia for cataract surgery
Eur J Implant Refract Surg
(1992)
M.C. Kraff et al.
Changing practice patterns in refractive surgeryresults of a survey of the American Society of Cataract and Refractive Surgery
J Cataract Refract Surg
(1994)
D.V. Leaming
Practice styles and preferences of ASCRS members-1985 survey
J Cataract Refract Surg
(1986)
T. Oshika et al.
Current trends in cataract and refractive surgery in Japan—1997 survey
Jpn J Ophthalmol
(1999)
T. Oshika et al.
Current trends in cataract and refractive surgery in Japan—1998 survey
Jpn J Ophthalmol
(2000)
D. Wong et al.
A survey of intraocular lens implantation in the United Kingdom
Trans Ophthalmol Soc UK
(1985)
R. Beckett et al.
The results of the 1986 survey of cataract surgery and intraocular lens implantation in the United Kingdom
Eur J Implant Refract Surg
(1987)
P.R. Hodgkins et al.
Current practice of cataract extraction and anaesthesia
Br J Ophthalmol
(1992)
P. Courtney
The national cataract surgery surveyI. Method and descriptive features
Eye
(1992)
O.D. Shein et al.
Variation in cataract surgery practice and clinical outcomes
Ophthalmology
(1994)

There are more references available in the full text version of this article.

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Citation Excerpt :
This is comparable with the response rate for surveys to ophthalmologists in the UK, which has previously been documented at 66%.6 The response rate is similar to surveys in Canada (358/698, 67%)7 and Singapore (88/144, 61.1%),8 and better than those in Japan (457/930, 49%)9 and the USA (985/6350, 15.5%).10 A survey in New Zealand which sent reminder letters did have a higher response rate (84/103, 84%).11
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Clinical investigationsCurrent Trends in Cataract and Refractive Surgery in Japan: 1999 Survey☆

Abstract

Introduction

Section snippets

Materials and Methods

Results

Discussion

Acknowledgements

Eur J Implant Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

Jpn J Ophthalmol

Jpn J Ophthalmol

A survey of intraocular lens implantation in the United Kingdom

Trans Ophthalmol Soc UK

The results of the 1986 survey of cataract surgery and intraocular lens implantation in the United Kingdom

Eur J Implant Refract Surg

Current practice of cataract extraction and anaesthesia

Br J Ophthalmol

The national cataract surgery surveyI. Method and descriptive features

Eye

Variation in cataract surgery practice and clinical outcomes

Ophthalmology

Clinical investigations
Current Trends in Cataract and Refractive Surgery in Japan: 1999 Survey☆