A growing number of ophthalmologists are focusing exclusively on providing cataract surgery, according to a new study in the Canadian Journal of Ophthalmology, leaving open the possibility for “fragmented care,” say researchers.

The population-based study in Ontario, Canada revealed that between 1994 and 2016, the number of ophthalmologists who only provided cataract surgery rose from 1 in 10 surgeons to 1 in 3.

Researchers looked at data recorded in the Ontario Health Insurance Plan across 2 decades to understand the extent to which ophthalmologists provided a diverse range of surgical services, as opposed to narrowly focused care. In particular, they examined which physicians only provided cataract surgery.


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Between 1994 and 2016, the proportion of ophthalmologists who solely provided cataract surgery rose from 10.0% (95% confidence interval: 7.01%13.1%) to 34.9% (95% confidence interval: 29.0%40.8%; P <.0001). By contrast, the proportions of ophthalmologists providing various types of subspecialized surgical care and the proportion providing exclusively nonsurgical care were relatively stable.

Also, glaucoma and cornea surgeons devoted a significant share of their surgical work to cataract surgery. Glaucoma operations formed a declining proportion of overall surgical cases for glaucoma surgeons as the cataract surgery proportion rose (P <.0001).

Additionally, in analyses limited to recent graduates (physicians in their first 5 years of independent practice), researchers found an increase in the exclusive provision of cataract surgery.

Researchers point to several probable reasons for the increased dominance of cataract surgery. As the number of fellowship training positions has grown, access to ophthalmologists with fellowship training has as well, making it more likely non-cataract cases will be referred, the study says. Also, according to the study, non-cataract operations often have higher risks of complications and require more frequent follow-up. 

This shift towards focusing only on cataract surgery increases the chances of fragmented care, with different aspects divided among multiple ophthalmologists. And this might make getting treatment more complicated for patients, especially for those in some geographic areas. However, evidence suggests that specialization and higher surgical volumes could also improve outcomes in some areas of care.

The trend towards specialization also shows the challenge of providing educational opportunities of enough breadth and depth for students to become competent in a wider range of procedures. The American Surgical Association blue ribbon committee report on surgical education concluded that medical surgical programs cannot expect to produce graduates with confidence in all areas of surgery.

Researchers believe the study may have important implications for policies regarding surgeon resources as well as residency and fellowship training program curricula and accreditation.

Reference

Campbell R, ten Hove M, Bell C, et al. Exclusive cataract surgical focus among ophthalmologists: a population-based analysis. Can J Ophthalmol. 2020;55(5):359-365. doi: 10.1016/j.jcjo.2020.05.003.