YAG Procedures Yield Similar Outcomes Between Advanced Nurse Practitioners, Ophthalmologists

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Clinicians can expect to see more ANP led procedures as they continue to successfully integrate into the eye care profession, a study suggests.

Advanced nurse practitioners (ANP) are capable of safely and effectively performing YAG posterior capsulotomy (YAGPC) procedures that will lead to excellent vision outcomes, according to a study published in Eye.

Researchers conducted a retrospective, consecutive case series of 6308 eyes (42.6% men, 26.8% with ocular comorbidities) that received YAGPC. A total of 111 ophthalmic professionals performed these procedures. Investigators classified those performing the treatments into 1 of 5 operator categories: staff grade associate specialist (SAS), ANP, residents, fellows, and consultants (n=1215, 208, 812, 959, and 1234 eyes, respectively), and collected demographic data on all participants including age, race, gender, and baseline visual acuity (VA) (median logMAR 0.48). 

Overall, VA improved significantly among the cohort (P <.001) with 68.1% of eyes improving, 24.7% remaining the same, and 7.3% experiencing reduced VA with respect to the logMAR line. Researchers noted a postoperative logMAR gain of 0.30 in patients among all groups of operators, with the exception of fellows (0.22 logMAR gain). Multivariate linear regression analysis revealed no difference in VA gain between the ANP and the other operator grades, except for the residents’ group, which showed a significantly higher VA improvement than the ANP (P =.020). 

Intraocular pressure rise was the only complication of statistical significance (P =.025) with occurrences of 0.3%, 0.1%, 0.6%, 0.9%, and 0.4% in the SAS, ANP, residents, fellows, and consultant groups, respectively. Other complications such as cystoid macular edema (P =.750), anterior uveitis (P =.251), and retinal detachment (P =.521) showed no statistical significance.

“Our study demonstrates that ANPs can deliver safe and effective YAGPC,” according to the investigators. “We are hopeful that this study will facilitate the integration of ANP-lead YAG services across other eye units.”

Study limitations include its retrospective nature, single center design, and possible confounding due to the likelihood that some patients may have taken post-operative, topical drops.


Moussa G, Kalogeropoulos D, Ch’ng SW, Panthagani J, Abdel-Karim Z, Andreatta W. Comparing outcomes of advanced nurse practitioners to ophthalmologists performing posterior YAG capsulotomy, a six-year study of 6308 eyes. Eye (Lond). Published online February 28, 2022. doi:10.1038/s41433-022-01986-8