Refractive Surgery Outcomes:
Standard Graphs for Reporting Refractive Surgery
In a medical specialty such as refractive surgery, the value of publishing the outcomes of a particular surgical technique, study, or case series is greatly increased if these outcomes are directly comparable to other publications.
For decades, the best way to achieve this has been through peer-reviewed journals that strictly adhere to a universal standard or format for reporting outcomes.
In 2000, George O. Waring III, in association with the editorial staffs of the Journal of Refractive Surgery and the Journal of Cataract and Refractive Surgery, published an article titled “Standard Graphs for Reporting Refractive Surgery”1 . The paper set out a concise six-graph format for reporting clinical outcomes, covering four main areas of accuracy, efficacy, safety and stability.
In November 2009, Professor Dan Reinstein and George O. Waring III, published an editorial in the Journal of Refractive Surgery outlining a number of improvements, reiterating the importance of adhering to the protocol set out in the Standard Graphs of Reporting Refractive Surgery when reporting outcomes.2
In January 2011, a joint editorial was published in the Journal of Refractive Surgery,3 the Journal of Cataract and Refractive Surgery4 and Cornea5 in which some final amendments were made to the graphs. The editorial also stated the commitment of these three journals to require authors to report their outcomes with a minimum standard of displaying the six standard graphs for data sets that lend themselves to this form of reporting.
In October 2014, the set of six graphs were expanded to nine in order to include further information about the correction of astigmatism, as set out in an editorial in the Journal of Refractive Surgery by Prof Reinstein, Timothy J. Archer, and J. Bradley Randleman.6
The figure shown here demonstrates the Standard Graphs of Reporting Refractive Surgery for an example population and an example of the Standard Graphs are published in virtually every issue of the JRS. These graphs can be easily created using standard spreadsheet software programs such as Microsoft Excel (Microsoft Corporation, Seattle, WA, USA) as well as other software programs designed specifically for refractive surgery outcomes analysis.
You can find an Excel template which can be used to produce the nine required graphs here.
We believe such efforts to improve the rigour of reporting refractive surgery outcomes is essential. Not only does it help us maintain an incredibly high safety and efficacy standard, but it allows us to continually improve on our already impressive outcomes.
- Waring GO, 3rd. Standard graphs for reporting refractive surgery. J Refract Surg. 2000;16(4):459-466. Erratum in: J Refract Surg. 2001;2017:following table of contents.
- Reinstein DZ, Waring GO, 3rd. Graphic Reporting of Outcomes of Refractive Surgery. J Refract Surg. 2009;25(11):975-978.
- Waring GO, 3rd, Reinstein DZ, Dupps WJ, Jr., Kohnen T, Mamalis N, Rosen ES, Koch DD, Obstbaum SA, Stulting RD. Standardized graphs and terms for refractive surgery results. J Refract Surg. 2011;27(1):7-9.
- Dupps WJ, Jr., Kohnen T, Mamalis N, Rosen ES, Koch DD, Obstbaum SA, Waring GO, 3rd, Reinstein DZ, Stulting RD. Standardized graphs and terms for refractive surgery results. J Cataract Refract Surg. 2011;37(1):1-3.
- Stulting RD, Dupps WJ Jr, Kohnen T, Mamalis N, Rosen ES, Koch DD, Obstbaum SA, Waring GO 3rd, Reinstein DZ. Standardized graphs and terms for refractive surgery results. Cornea. 2011 Aug;30(8):945-7.
- Reinstein DZ, Archer TJ, Randleman JB. JRS standard for reporting astigmatism outcomes of refractive surgery. J Refract Surg. 2014 Oct;30(10):654-9.