London, UK: A total of 363,039 cataract surgeries performed in 12 European countries in 2024 have been recorded in the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO), according to the latest figures presented at the 44th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS) today (Tuesday). [1]
Since 2007 when EUREQUO was established, the registry has recorded nearly five million cataract surgeries, and it shows that safety and efficacy continue to improve. However, the cost of some of the newer types of lenses means that not every patient will have access to the latest technology.
Dr Carlo Bellucci, a research fellow at the University of Parma, Italy, told the congress: "Overall, the results are excellent across Europe. However, because such a huge number of procedures are performed every year, even small improvements can make a meaningful difference for thousands of patients. This is why the work of the ESCRS Registries Committee in maintaining and continuously developing the EUREQUO database is so valuable, encouraging surgeons and clinics to benchmark their results and continuously strive for better outcomes."
Sweden and The Netherlands have national registries recording the outcomes of cataract surgery and so have data from all clinics feeding into the EUREQUO database. Clinics in the other countries also send data but not every clinic participates [2]. The data include patient demographics, information on how good or bad their eyesight was before cataract surgery, other eye problems, the type of surgery and the type of intraocular lenses (IOL) they received, any complications encountered during or after surgery, the measurements of the characteristics of their eyes (biometry), which is essential for the precise calculation of the power of the replacement lens and refractive outcomes after surgery, i.e. whether the patients have perfect sight, or still are short-sighted or long-sighted, or have astigmatism or presbyopia (when older adults find it difficult to focus on near objects or text).
The most common cataract surgery, accounting for 98.9% of procedures was phacoemulsification with posterior IOL implant. This involves inserting a probe through a small cut in the eye to use ultrasonic energy to break up the lens into small pieces, which are then sucked out of the eye through the probe. The replacement IOL is inserted into the eye and a solution is injected to help the lens unfold. The tiny cuts involved in this type of surgery mean they heal on their own. The replacement IOL is usually monofocal, meaning that it is designed to provide clear vision at a single distance, and does not correct pre-existing astigmatism.
Among high-technology IOLs, toric IOLs, which are designed to correct astigmatism, were the most frequently used. Prices for the entire surgery in the private setting start at around £3,400 or €4000 per eye in the UK and EU respectively, although the final cost may depend on the type of IOL technology used.
Posterior capsule rupture, in which the thin membrane surrounding the lens tears, was the most common complication during surgery, occurring in 0.39% of procedures. If it happens it can lead to other complications such as vitreous gel entering the anterior chamber between the iris and the cornea's innermost surface, and difficulties in lens placement.
EUREQUO has follow-up data for 54% of the patients included in the database, and Dr Bellucci said: "This represents an exceptionally large and robust dataset from which reliable conclusions can be drawn."
After cataract surgery, the registry found that Best Corrected Visual Acuity (BCVA) – a measure of how well the patient can see – improved from an average of 0.448 pre-operatively to 0.939 post-operatively (using the decimal notation system [3]); BCVA of 0.5 or more was achieved in 92.6% of eyes and 1.0 or more in 68.6%. Biometry was accurate (mean absolute biometry prediction error of 0.56 diopter, with 84.95% of eyes within 1.0 diopter of target). Cystoid macular oedema (fluid accumulation in the macula) was the most common post-operative complication, occurring in 0.13% of eyes.
"The annual EUREQUO report, produced by the ESCRS Registries Committee, demonstrates consistent progressive improvement in cataract surgery outcomes over the years," said Dr Bellucci.
"Over the next few years, I expect that we will see an evolution in IOL technology with the development of simultaneous vision IOLs that have the goal of restoring vision at all distances, while minimising or eliminating the need for spectacles. At present, their adoption is still limited by cost and technical research is progressing."
ESCRS President, Professor Burkhard Dick, chair of the ophthalmology department at the University Eye Hospital Bochum, Germany, who was not involved in the research, said: "The ESCRS funds EUREQUO because we strongly believe there should be ongoing surveillance of the safety, effectiveness and quality of cataract and refractive surgery to move forward in our speciality.
"As demonstrated by the most recent report, outcomes in Europe are outstanding, with very low complication rates and improved visual and refractive results.
"On the other hand, it is important for us to be critical: the registry is only as good as the data we provide, and greater participation by European ophthalmologists in the EUREQUO study is necessary. This will allow us to compare results and identify ways to improve. We are also hoping for greater availability of advanced lenses in the future."
