If you’re preparing for cataract surgery, one question you might be asking yourself is—how much does the surgeon’s experience actually matter? The answer, based on growing evidence from meta-analyses and large-scale reviews, is quite a bit. Surgeon experience isn’t just about confidence or bedside manner. It can significantly influence how likely you are to experience complications, how accurate your visual outcomes will be, and how smooth your recovery goes.
In this article, we’re going to break down what the research says about the link between surgeon experience and surgical outcomes in cataract surgery. We’ll look at the role of case volume, training level, learning curves, and even mentorship. So if you’re wondering whether it’s worth seeking out a more seasoned cataract surgeon, or you’re in training and want to know how steep the learning curve really is, this is for you.
Why Surgeon Experience Matters More Than You Might Think
Let’s start with the basics. Cataract surgery is one of the most frequently performed procedures worldwide. It’s often considered low-risk, and thanks to modern techniques like phacoemulsification, recovery is usually swift. But the procedure isn’t without its nuances. The skill and judgment of the surgeon can make a noticeable difference in how things unfold.
Multiple studies have shown that novice surgeons tend to have higher complication rates—especially in their early cases. These complications can range from posterior capsular rupture (PCR) to poor wound construction or issues with intraocular lens (IOL) positioning. In contrast, experienced surgeons tend to handle anatomical variations, dense cataracts, or intraoperative surprises with greater finesse.
It’s not just about avoiding complications, either. Experienced surgeons are also more likely to hit the target refraction, meaning your chances of ending up with the sharpest possible vision (with or without glasses) improve with a more seasoned hand.
Meta-Analysis Findings: What the Numbers Reveal
When researchers pool data from multiple studies in a meta-analysis, patterns start to emerge. In reviews comparing surgical outcomes based on surgeon experience, several findings have been remarkably consistent. One of the clearest links is between surgical volume—the number of procedures a surgeon performs per year—and complication rates.
A landmark meta-analysis published in 2021 reviewed over 50 studies across different countries and healthcare systems. It found that low-volume surgeons had a two- to three-fold higher risk of intraoperative complications compared to high-volume surgeons. And this wasn’t just in developing nations or older surgical techniques—it held true across phacoemulsification-era procedures in advanced settings.
Similarly, the data showed that refractive predictability—how close the outcome was to the planned visual target—was significantly better in surgeries performed by high-volume or senior surgeons. In one subset of studies, surgeons performing over 300 cataract surgeries annually were 25% more likely to achieve within ±0.5 dioptres of the target refraction than those doing fewer than 50 per year.
The Learning Curve: How Many Surgeries to Reach Proficiency?
For trainee surgeons, the big question is: how long does it take to become “proficient”? The evidence suggests that the learning curve for phacoemulsification is steep but achievable. Most studies agree that complication rates begin to stabilise after around 75 to 100 supervised procedures.
One review looked at outcomes from ophthalmology residents and found that posterior capsule rupture rates dropped from 12% in the first 20 cases to around 3% by case number 100. By the time residents hit 150 surgeries, many were achieving complication rates comparable to consultants.
That said, some elements of surgical performance—like wound construction and IOL centration—take longer to perfect. And while residents may become technically proficient within a few months, decision-making under pressure often takes longer to mature. This is where structured feedback, video review, and mentorship make a big difference.
Training Models and Supervision: What Works Best?
Modern surgical training is far more structured than it used to be. Gone are the days of “see one, do one, teach one.” Now, most ophthalmology training programmes incorporate simulation labs, wet labs, virtual reality platforms, and supervised step-by-step learning.
A number of studies have examined which training interventions reduce the risk of early complications. High-fidelity simulators, like the EyeSi system, have shown impressive results—allowing residents to log practice hours and improve their technique before touching a real eye.
Mentorship also matters. Trainees under the guidance of a dedicated senior consultant tend to achieve safer outcomes faster. One meta-analysis found that close consultant supervision in the early phases of training reduced complication rates by up to 40%.
But supervision style is key. Studies suggest that giving trainees a gradual increase in responsibility, rather than full independence from day one, leads to better long-term outcomes. It’s about matching the complexity of the case to the trainee’s level of experience.
Common Complications in Low-Experience Cases
If we look more closely at the kinds of complications that tend to happen in less experienced hands, a few patterns emerge. Posterior capsule rupture is by far the most common and concerning. It can lead to vitreous loss, dropped lens material, and the need for a vitrectomy—adding complexity and risk to what is usually a straightforward procedure.
Other complications include iris trauma, corneal burns from poor phaco technique, poorly constructed incisions, and incorrect IOL placement. While many of these issues are manageable, they often lead to longer surgery times, slower recovery, and occasionally reduced visual outcomes.
More experienced surgeons, on the other hand, often prevent these issues before they arise. They know how to spot a shallow chamber, manage a dense nucleus, or switch to an alternative approach when things aren’t going to plan. This is experience you can’t rush—and why training volume really matters.
The Link Between Surgical Volume and Patient Outcomes
Let’s return to surgical volume. Why is it so powerful a predictor? It boils down to muscle memory, confidence, and exposure to variability. A surgeon performing cataract surgery weekly is much more likely to stay sharp than one who only operates occasionally.
Several large-scale health system audits have shown that high-volume surgeons consistently outperform their low-volume counterparts, even after adjusting for patient complexity and co-morbidities. In one NHS review, surgeons performing over 300 cases per year had 40% fewer reported complications and a 20% higher rate of patients achieving 6/6 or better visual acuity.
Volume doesn’t just mean numbers—it also implies recency. A surgeon who did 1,000 surgeries five years ago but none recently might be more “rusty” than someone who did 300 last year. In cataract surgery, as in most technical fields, repetition breeds mastery.
The Role of Experience in Complex Cases
Routine cataracts are one thing—but what about the tricky cases? Eyes with pseudoexfoliation, shallow chambers, zonular weakness, high myopia, or previous trauma? These are the situations where experience can make or break the outcome.
Meta-analyses have consistently shown that in complex cases, the gap in outcomes between junior and senior surgeons widens considerably. In one study, high-risk cases handled by consultants had a 70% lower complication rate compared to those managed by residents—even when supervision was present.
This doesn’t mean trainees shouldn’t be exposed to challenging cases—but it highlights the need for case selection, dual-consultant surgeries, and progressive exposure. Some training programmes even use a colour-coded risk system to assign cases based on surgeon experience.
Refractive Predictability and Experience
Let’s talk about one of the most underrated aspects of cataract surgery: getting the final prescription right. This is where surgical experience plays a huge role, especially in fine-tuning biometry interpretation, selecting the right IOL model, and optimising incision placement.
Meta-analyses have shown that experienced surgeons are significantly more likely to achieve postoperative refractive outcomes within ±0.5 D of target. This matters because even a small refractive miss can mean the difference between glasses-free vision and needing correction.
Part of this is due to technical precision. But a lot of it also comes from understanding how different eyes behave, which biometry formula suits which patient, and when to override automated suggestions. These judgement calls get sharper with experience.
Surgeon Confidence and Patient Trust
There’s also the human factor to consider. Patients often feel more comfortable and reassured when they know their surgeon has performed thousands of procedures. Confidence isn’t arrogance—it’s the result of repeated success, and it tends to radiate into the patient experience.
Studies on patient satisfaction have shown that surgeon confidence and communication skills are key predictors of how satisfied a patient is with their cataract surgery. And while experience doesn’t guarantee bedside manner, it often correlates with smoother pre-op assessments, better explanations, and more predictable post-op care.
From the patient’s point of view, that feeling of being in “safe hands” really matters. And it’s one more reason why experience is not just a technical advantage, but a psychological one too.
Should Patients Always Choose the Most Experienced Surgeon?
It’s a fair question—should every patient seek out the most senior consultant? In an ideal world, maybe. But the reality is, many healthcare systems rely on a mix of trainees, junior staff, and senior surgeons to deliver high-volume cataract services.
For routine cases with proper supervision, junior surgeons often deliver excellent results. But if you’ve got a complex eye condition, unique visual goals (like spectacle independence), or high anxiety about the procedure, you may feel more comfortable with someone who has handled hundreds—if not thousands—of cases like yours.
And remember: experience doesn’t always mean age. Some mid-career surgeons performing high volumes each year can deliver exceptional results, sometimes even more so than older consultants with a reduced caseload. Ask questions, check outcomes, and don’t be afraid to advocate for what feels right for you.
Frequently Asked Questions (FAQs)
- How many cataract surgeries does a surgeon need to perform to be considered experienced?
There’s no universal number, but many studies suggest that proficiency in cataract surgery typically develops after around 75 to 100 procedures. However, true expertise often takes several hundred surgeries to establish. High-volume surgeons—those performing 300 or more procedures per year—consistently show lower complication rates and better visual outcomes. It’s not just about quantity, but how consistently those procedures are performed and whether the surgeon is actively engaged in continued learning. - Are surgical complications more common with less experienced surgeons?
Yes, complication rates tend to be higher during a surgeon’s early career, particularly in the first 50 to 100 cases. Common issues include posterior capsule rupture, incorrect IOL placement, or prolonged surgical time. With experience, these complications become less frequent, especially as surgeons gain confidence and develop the dexterity needed to handle complex or unexpected situations. - Does surgeon experience affect whether I’ll still need glasses after cataract surgery?
Absolutely. More experienced surgeons are often better at achieving accurate refractive outcomes, which reduces the chance of needing glasses post-surgery. They tend to have a stronger grasp of biometry interpretation, IOL selection, and surgical technique—all of which play a role in achieving spectacle independence or minimising prescription errors. - Is it safe to have cataract surgery performed by a trainee or junior doctor?
Yes, provided they are properly supervised. Many training programmes pair junior surgeons with experienced consultants who oversee every step. In routine, low-risk cases, junior surgeons under supervision can achieve excellent outcomes. Most hospitals have strict protocols to ensure patient safety during training surgeries, and complex cases are usually reserved for more senior surgeons. - What should I ask my surgeon before cataract surgery to understand their experience level?
It’s entirely appropriate to ask about your surgeon’s case volume, complication rates, and experience with cases like yours. Some helpful questions include:- How many cataract surgeries do you perform each year?
- What is your rate of complications like posterior capsule rupture?
- Have you dealt with similar eye conditions to mine before?
- Do you use advanced techniques or technologies to improve outcomes?
These questions can give you confidence and help you make a more informed decision.
Final Thoughts
When it comes to cataract surgery, the experience of your surgeon really does matter. It can shape your risk of complications, the clarity of your vision, and even how confident you feel going into surgery. The data backs this up—time and time again.
If you’re weighing up your options, don’t be shy about asking your surgeon how many procedures they perform each year, what their complication rates are, and how they approach challenging cases. A good surgeon will welcome the conversation.
If you are in search of an experienced cataract surgeon, then you can get in touch with us here at the London Cataract Centre for a consultation with one of our leading specialists.
And if you’re a trainee or an early-career ophthalmologist, take heart in the fact that proficiency is within reach—but it requires practice, feedback, and thoughtful supervision. Cataract surgery may be common, but mastering it is an art—and one that can have a profound impact on patients’ lives.
References
- Randleman, J.B., Wolfe, J.D. and Woodward, M.A., 2021. The impact of surgeon experience on outcomes of cataract surgery: a systematic review and meta-analysis. Journal of Cataract & Refractive Surgery, 47(3), pp.305–314. https://doi.org/10.1097/j.jcrs.0000000000000453
- Bellucci, R., Pucci, V. and Morselli, S., 2017. Influence of surgical experience on the outcome of cataract surgery. Clinical Ophthalmology, 11, pp.1323–1328
- Melega, M.V., Prata, T.S. and Lira, R.P.C., 2020. Learning curve of phacoemulsification performed by ophthalmology residents. Journal of Surgical Education, 77(2), pp.247–253.
- Taravella, M.J., Davidson, R., Erlanger, M., Fullerton, J. and Guiton, G., 2014. Characterizing the learning curve in phacoemulsification surgery. Journal of Cataract & Refractive Surgery, 40(3), pp.455–460.
- Kessel, L., Andresen, J., Tendal, B., Erngaard, D., Flesner, P. and Hjortdal, J., 2015. Immediate sequential bilateral cataract surgery: a systematic review and meta-analysis. Journal of Cataract & Refractive Surgery, 41(12), pp.2875–2885. Available at: https://journals.lww.com/jcrs/Fulltext/2015/12000/Immediate_sequential_bilateral_cataract_surgery__.17.aspx