Biomedical subjects

O D Schein

Publications and source records attributed to O D Schein.

At least 73 records · Page 4Linked to original sources

PubMed1995

Do ophthalmologists, anesthesiologists, and internists agree about preoperative testing in healthy patients undergoing cataract surgery?

To assess variation in reported use of preoperative medical tests in patients undergoing cataract surgery and to identify factors that influence test use by different physician groups we performed a national survey of ophthalmologists, anesthesiologists, and internists. Participants included randomly selected members of American professional societies who provided care to one or more patients undergoing cataract surgery in 1991. Responses were obtained from 538 (82%) of 655 eligible ophthalmologists, 109 (76%) of 143 anesthesiologists, and 54 (44%) of 122 internists. Fifty percent of ophthalmologists, 40% of internists, and 33% of anesthesiologists frequently or always obtained a chest x-ray film, while 20% of ophthalmologists, 27% of internists, and 37% of anesthesiologists never obtained a chest x-ray film for patients being considered for cataract surgery who had no history of major medical problems (P < .01 for differences between ophthalmologists and the other groups). Similarly, 70% to 90% of ophthalmologists, 73% to 79% of internists, and 41% to 79% of anesthesiologists frequently or always obtained a complete blood cell count, electrolyte panel, and electrocardiogram, while 4% to 11% of ophthalmologists, 13% to 17% of internists, and 9% to 28% of anesthesiologists never obtained these tests for such patients. Many respondents (32% to 80%) believed tests were unnecessary but cited multiple reasons for obtaining tests (eg, medicolegal concerns and institutional requirements). Many physicians in each group viewed preoperative evaluations as screening opportunities or believed that one of the other two types of physicians "required" tests. We conclude that marked variation exists within and across physician specialties in the use and rationale for use of medical tests in patients undergoing cataract surgery.

Anesthesiology↗

PubMed1995

Preoperative functional expectations and postoperative outcomes among patients undergoing first eye cataract surgery.

OBJECTIVE: To describe the relationship between patients' preoperative expectations regarding the outcome of cataract surgery and actual postoperative experience. METHODS: A longitudinal study of 772 patients undergoing first eye cataract surgery recruited from 75 ophthalmology practices in three metropolitan areas was conducted. Prior to surgery and approximately 4 months after surgery, a detailed interview was conducted that included general and vision-specific health status measures (including the Visual Function 12-Item Scale [VF-12]), patient-reported level of trouble and satisfaction with vision, and questions addressing patients' preoperative expectations regarding the outcomes of surgery. In addition, detailed clinical data were collected preoperatively and postoperatively. A total of 552 patients had only single eye cataract surgery by 4 months postoperatively and are included in this analysis. RESULTS: Patients' preoperative expectations regarding the impact of cataract surgery were very high and were unrelated to their demographic or ocular characteristics. The preoperative VF-12 score, however, was positively correlated with expected postoperative VF-12 score (Spearman correlation, .45, P < .001). Only 61% of patients achieved or surpassed their expected level of postoperative functioning. The difference between expected and actual postoperative VF-12 scores was not associated with patients' demographic characteristics or provider-related variables. Older patients (> 75 years) and patients with ocular comorbidity had a larger difference between expected and actual postoperative functioning than younger patients and those without ocular comorbidity. CONCLUSION: Expectations regarding visual functioning after cataract surgery are very high, and in most cases such expectations are fulfilled. In selected cases, more comprehensive counseling may reduce the discrepancy between expectations and actual outcomes of cataract surgery.

Aged↗

PubMed1995

Cigarette smoking and risk for progression of nuclear opacities.

OBJECTIVE: To examine the relationships between smoking and the 5-year incidence of new nuclear opacities and between smoking and the progression of nuclear opacities in a prospective study of a cohort of Chesapeake Bay watermen. METHODS: A total of 442 men (age, > or = 30 years in 1985) with paired, gradable lens photographs in at least one eye in both 1985 and 1990 were studied. Photographs were graded by two readers who used the grading scheme of the Wilmer Institute, Baltimore, Md, with severity ranging in decimal units between 0.0 and 4.0. Data on the smoking history of the subjects were collected by personal interviews that were conducted in 1985 and updated in 1990. RESULTS: The incidence and progression of opacities increased with age. A nonsignificant association was observed between smoking (for both current and ex-smokers) and the incidence of a nuclear opacity. The risk of progression of nuclear opacities of less than grade 3 at baseline to grade 3 or worse was 2.4-fold higher among current smokers in 1985, compared with that among ex-smokers and nonsmokers (95% confidence limits: 1.0, 6.0) after adjustment for age, baseline opacity status, and alcohol use. An 18% increased risk of progression was significantly associated with each pack-year that a subject smoked between 1985 and 1990. CONCLUSION: These data confirm previous findings that smoking is associated with a nuclear opacity, particularly with progression to severe opacities.

Adult↗

PubMed1995

Reproducibility and responsiveness of the VF-14. An index of functional impairment in patients with cataracts.

OBJECTIVES: To assess the test-retest reliability and responsiveness of the VF-14, which is an index of functional impairment in patient with cataracts. DESIGN: Observational longitudinal study. Patients were enrolled prior to undergoing their first cataract surgery between July 15 and December 15, 1991, and they were followed up for 1 year after surgery. SETTING: Patients were recruited from 72 ophthalmologists' practices in three US cities. PATIENTS: Five hundred fifty-two patients who had undergone a surgical procedure in only one eye by the 4-month postoperative follow-up (responsiveness analyses) and a subset of these (n = 426) who had not subsequently undergone surgery for the second eye by the 12-month postoperative follow-up (reproducibility analyses). MAIN OUTCOME MEASURES: Two health status measures (the VF-14 and the Sickness Impact Profile, two global measures of a patient's trouble and satisfaction with his or her vision, and best corrected visual acuity in each eye. RESULTS: The VF-14 is highly reproducible, with an intraclass correlation coefficient of .79 when patient-rated criteria are used to define stable patients. The intraclass correlation coefficient was lower (.57 to .71) when various measures of visual acuity were used to define stable patients. The VF-14 is also about three times more responsive to a change in vision than the Sickness Impact Profile, which is a generic health status measure (effect size of approximately 1.00 vs 0.30). Estimates of the responsiveness of the VF-14 and the Sickness Impact Profile were not associated with preoperative visual acuity in the operated on or better eye. Responsiveness of the VF-14, however, was higher in patients with greater self-rated trouble with vision preoperatively. CONCLUSIONS: The VF-14 was reproducible in stable patients during an 8-month period, and it was more responsive to clinically significant changes in vision than was a generic health status measure (ie, the Sickness Impact Profile).

Aged↗

PubMed1995

Cataract surgery in one eye or both. A billion dollar per year issue.

PURPOSE: To measure the relative effect of cataract surgery in the second eye compared with the first eye on functional impairment, satisfaction, and vision problems. METHODS: Seventy-five randomly selected ophthalmologists in three cities in the United States were enrolled in a National Study of Cataract Outcomes. They, in turn, referred eligible, sequential patients scheduled for first-eye cataract surgery. Interviews were conducted at enrollment, 4 months after first-eye surgery, and 12 months after first-eye surgery. An attempt was made to conduct a special, preoperative interview of those patients scheduled to undergo second-eye surgery before the 4-month interview. Each interview included administration of the VF-14 (a 14-item questionnaire that assessed visual function), as well as questions about symptoms possibly related to cataract, "trouble with vision," and satisfaction with vision. RESULTS: Seven hundred seventy-two patients were enrolled in the study, and interview data to 12 months were obtained from 669 (86%) patients. Of these patients, 243 (36%) underwent cataract extraction in the second eye during the 12-month period of observation. Overall, subjects who underwent cataract surgery in both eyes during the 12-month period had 61% greater improvement in VF-14 score (P < 0.001), 27% more decline in trouble with vision (P < 0.001), and 24% greater improvement in satisfaction with vision (P < 0.001) compared with those who underwent surgery in only one eye. CONCLUSIONS: Cataract surgery in the second eye of patients with bilateral cataract is associated with clinical and statistically significant improvement in functional impairment, trouble with vision, and satisfaction with vision.

Aged↗

PubMed1995

Predictors of outcome in patients who underwent cataract surgery.

PURPOSE: To identify preoperative patient characteristics associated with a lack of improvement on one or more measures 4 months after cataract surgery. METHODS: The authors collected preoperative and 4-month postoperative information on 552 patients undergoing first-eye cataract surgery from the practices of 72 ophthalmologists in three cities. The principal outcomes assessed were (1) Snellen visual acuity, (2) a cataract-related symptom score (possible range: 0, 0 of 6 symptoms present or bothersome, to 18, all 6 symptoms very bothersome), and (3) a measure of functional impairment in patients with cataract--the VF-14 score (possible range: 0, inability to perform any of the applicable activities, to 100, no difficulty performing any of the applicable activities). Multiple logistic regression was used to assess the association between preoperative patient characteristics and failure to improve on one or more outcome measures. Multiple linear regression was used to estimate the adjusted rate of lack of improvement in one or more outcome measures for one group of patients compared with another. RESULTS: Although 91 patients (16.5%) failed to improve on one or more of the outcome measures assessed, only 2 (0.4%) failed to improve on all three measures. The 91 patients who did not improve on at least one measure were approximately one sixth as likely to be satisfied with their vision postoperatively as the 461 patients who improved on all three outcome measures. Preoperative age of 75 years of age or older, VF-14 score of 90 or higher, cataract symptom score of 3 or lower, and ocular comorbidity (glaucoma, diabetic retinopathy, or age-related macular degeneration) were associated independently with increased likelihood of not improving on one or more measure (odds ratio: 3.57, 2.10, 3.29, and 2.16, respectively). The mean adjusted rate of failure to improve on at least one of the outcome measures ranged from 20.5% to 26.5% for patients with these preoperative characteristics compared with 8.8% to 13.8% for those patients without them. The preoperative level of Snellen visual acuity was not associated with the likelihood of not improving on one or more of the outcomes assessed. CONCLUSIONS: The authors conclude that specific preoperative characteristics (age, comorbidity, cataract symptom score, and VF-14 score) are independent predictors of patient outcome after cataract surgery.

Aged↗

PubMed1995

Geographic variation in utilization of cataract surgery.

Cataract surgery is the most frequently performed surgical procedure on Medicare beneficiaries, with an annual cost to the Medicare program of more than $3.4 billion. In this study, the relationship between demographic, environmental, and provider-related factors, and the likelihood that cataract surgery will be performed on a Medicare beneficiary were assessed. The association between likelihood of cataract surgery and patient age, sex, race, income, and latitude of residence was examined, as was the association with the supply of ophthalmologists and optometrists in each region, and the allowed charge for cataract surgery and cost of practice in a region. This cross-sectional, population-based study used administrative data. Both regional models, using least-squares regression and person-based models, using logistic regression were employed. A random 5% sample of 1986 and 1987 Medicare beneficiaries, 65 years of age and older, were included in the study. Medicare beneficiaries who lacked continuous Part A and Part B coverage during 1986 and 1987, or who were enrolled in a health maintenance organization at any time during this 2-year period of observation were excluded from the study to make certain that complete utilization data were available for each individual. Rate of cataract surgery per 1,000 Medicare beneficiaries in each Bureau of Economic Analysis Economic Area (BEAEA) and the likelihood of an individual with particular characteristics undergoing cataract surgery were determined in separate regression models. The mean annual rate of cataract surgery during 1986 and 1987 in the 181 BEAEAs was 25.4 surgeries per 1,000 persons 65 years of age or older (standard deviation = 6.2, coefficient of variation = 0.24). Both the regional model and the person-based model detected an association between a higher rate of and personal likelihood of cataract surgery and female gender, more southerly latitude, higher concentration of optometrists per 1,000 Medicare beneficiaries, and higher allowed charge for cataract surgery, after adjusting for variation in practice expense. The person-based model additionally demonstrated that increased likelihood of undergoing cataract surgery was associated with increasing age from 65 to 94 years, white race, and living in a zip-code area with mean income greater than $15,000. Neither analysis detected a statistically significant association between the concentration of ophthalmologists per 1,000 Medicare beneficiaries and the regional rate of, or an individual's likelihood of, cataract surgery. Compared with the geographic variation in provision of other surgical procedures, the variation in cataract surgery across large geographic areas observed in this analysis was relatively low.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗

PubMed1995

Ocular and dermatologic health effects of ultraviolet radiation exposure from the ozone hole in southern Chile.

OBJECTIVES: This study sought to investigate numerous reports emanating from Punta Arenas, Chile (population 110,000, latitude 53 degrees S), that associated acute ocular and dermatologic disease in humans and animals with excess ultraviolet-B (UV-B) exposure in the setting of the thinning of the ozone column. METHODS: Ophthalmologic and dermatologic records in Punta Arenas were systematically reviewed to enumerate sentinel diagnoses potentially associated with UV-B exposure, ocular examinations on representative animal populations were performed, and the ambient UV-B exposure in the region during the time of maximal thinning was estimated. RESULTS: No increase in patient visits or conditions attributable to UV-B exposure was seen for periods of known ozone depletion compared with control periods. Although ambient UV-B exposure was 1.6 to 2.3 times the habitual exposure on individual days, this excess exposure conferred only a 1% increase in annual exposure on the region. CONCLUSION: This study does not support existing lay reports of ocular and dermatologic disease in humans and animals that had been associated with the ozone hole over southern Chile.

Animals↗

PubMed1995

Comparison of generic versus disease-specific measures of functional impairment in patients with cataract.

The increased demand for health status measures in evaluating medical interventions has increased the importance of clarifying when to use generic versus disease-specific health status measures. The authors compared the performance of a well known generic health status measure, the Sickness Impact Profile (SIP), and a disease-specific measure of functional impairment related to vision (the VF-14) in detecting functional impairment in 426 cataract patients before and at 12 months after first eye cataract surgery. Using analysis of covariance models, the associations were assessed between the SIP and VF-14 and four criterion variables--patient ratings of trouble and satisfaction with their vision and overall health, and best corrected visual acuity--after controlling for patient age and medical comorbidities. Preoperative patient ratings of trouble and satisfaction with vision were significantly associated with VF-14 scores (P < 0.001), but not with SIP scores. Preoperative visual acuity in the better eye was significantly associated with both VF-14 and SIP scores (P < 0.001). Patient general health ratings were significantly associated with SIP scores (P < 0.001), but not with VF-14 scores. Postoperative changes in patient ratings of their vision and in visual acuity were significantly associated with changes in VF-14 scores (P < 0.05), but not with changes in SIP scores. Changes in patient ratings of overall health were significantly associated with changes in SIP scores (P < 0.01), but not with changes in VF-14 scores. In patients undergoing cataract surgery, a disease-specific health status measure is more sensitive to preoperative functional impairment related to vision, and to change in functional impairment after cataract surgery, than is a generic health status measure.

Activities of Daily Living↗

PubMed1994

The context and consequences of ocular injuries from air guns.

There is little available information on the context of air-gun inflicted ocular injuries. To address this need, we performed a systematic telephone survey of victims of severe air-gun ocular injuries, collected between January 1986 and August 1992, through the auspices of the National Eye Trauma System and the Alabama Eye Injury Registry. One hundred forty interviews were completed with injury victims or their parents. Pump-action rifles with BB ammunition were the most common weapons. Victims and shooters were predominantly male (91% and 89%, respectively) and their mean age was 13 years. Of the injuries, 95% were inflicted by individuals known to the victim; 40% of these were relatives. People were the intended targets in 45% of the injuries. Ricochets accounted for 26% of the injuries. Of those victims with penetrating injuries, 84% had visual acuity less than 20/200 despite numerous surgical attempts. Adults were present at the scene of the injury in only 11% of the incidents, implying that unrestricted access to these weapons by children is likely the principal risk factor for injury.

Adolescent↗

PubMed1994

The impact of overnight wear on the risk of contact lens-associated ulcerative keratitis.

OBJECTIVE: To assess the relative risk of contact lens-associated ulcerative keratitis by lens type and related lens-wearing behavior. DESIGN: Case-control study. SETTING/PARTICIPANTS: Forty practice-based case patients with contact lens-associated ulcerative keratitis and 180 control patients matched to the case patients' dispensing practitioner and date of contact lens prescription. RESULTS: Compared with users of daily-wear soft lenses, users of disposable soft contact lenses had a 13.33-fold (95% confidence interval [CI], 5.35 to 33.20) excess risk of ulcerative keratitis. However, after adjusting for overnight wear, the excess risk associated with disposable contact lenses is reduced to 3.21 (95% CI, 1.22 to 14.36). Overall, overnight wear of contact lenses conferred an 8.25-fold excess risk (95% CI, 3.33 to 25.58) of ulcerative keratitis after controlling for lens type. No protective effect of standard compared with substandard lens hygiene was found. The risk of ulcerative keratitis attributable to overnight wear was estimated at 49% for users of daily-wear lenses and 74% for users of lenses approved for overnight wear. CONCLUSION: Overnight wear of contact lenses is the overwhelming risk factor for ulcerative keratitis among contact lens users. We estimate that 49% to 74% of cases of contact lens-associated ulcerative keratitis could be prevented by eliminating overnight wear.

Adolescent↗

PubMed1994

Rigor of research methods in studies of the effectiveness and safety of cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team.

OBJECTIVE: To assess the rigor of research methods reported in studies of the safety or effectiveness of contemporary cataract surgery. DESIGN: Formal systematic identification of pertinent studies and critical appraisal of each study's research methods. SUBJECTS: From 6113 unique, potentially relevant citations that we identified, 90 original studies published between 1979 and 1991 that addressed visual acuity or complications following standard extracapsular cataract extraction with posterior chamber intraocular lens implantation, phacoemulsification with posterior chamber intraocular lens implantation, or intracapsular cataract extraction with flexible anterior chamber intraocular lens implantation. MAIN OUTCOME MEASURES: Strength of study design, performance, and reporting in 11 methodologic areas assessed with a standardized abstraction form by two reviewers masked to authors, their institutions, and the journal of publication. Results of reviews were tallied to produce an overall quality score (measure of rigor in research methods) for each study. RESULTS: The mean (+/- SD) quality score was 43.1 +/- 20.1 out of a maximum possible score of 100. Studies received intermediate scores on description of baseline ocular disease and low scores on descriptions of other characteristics of enrolled patients, standardization of outcome assessment and follow-up duration, and handling of patient attrition. Eighty-three studies (92%) lacked a comparison group. The rigor of research methods in studies varied by the journal of publication, did not improve over time, and was no greater for studies with larger vs smaller sample sizes. CONCLUSIONS: The rigor of research methods in studies of cataract surgery can be improved if more attention is paid to fundamental principles of study design, data analysis, and reporting.

Cataract Extraction↗

PubMed1994

Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team.

OBJECTIVE: To better define the effectiveness and risks of modern cataract surgery. DESIGN: Meta-analysis (formal systematic identification, selection, review, and synthesis) of published literature. PATIENTS: Patients described in 90 studies published between 1979 and 1991 that addressed visual acuity (n = 17,390 eyes) or complications (n = 68,316 eyes) following standard extracapsular cataract extraction with posterior chamber intraocular lens implantation, phaco-emulsification with posterior chamber intraocular lens implantation, or intracapsular cataract extraction with flexible anterior chamber intraocular lens implantation. MAIN OUTCOME MEASURES: The proportion of eyes with postoperative Snellen visual acuity of 20/40 or better and the proportion of eyes with each of 18 complications. RESULTS: The pooled percentage of eyes (weighted by sample size) with postoperative visual acuity of 20/40 or better was 95.5% (95% confidence interval [CI], 95.1% to 95.9%) among eyes without preexisting ocular comorbidity and 89.7% (95% CI, 89.3% to 90.2%) for all eyes. The pooled percentage of eyes experiencing complications (weighted by sample size and, when pertinent, by quality score of the individual studies but not adjusted for variation in duration of follow-up) ranged from 0.13% for endophthalmitis to 19.7% for posterior capsule opacification. Pooled proportions of eyes with other complications were as follows: bullous keratopathy, 0.3%; intraocular lens malposition/dislocation, 1.1%; clinically apparent cystoid macular edema, 1.5%; and retinal detachment, 0.7%. Pooled results for postoperative Snellen visual acuity and most complications were similar for surgery performed via phacoemulsification vs standard extracapsular cataract extraction, although comparisons of the outcomes between these procedures should be interpreted with caution. CONCLUSIONS: The published literature indicates that modern cataract surgery yields excellent visual acuity and, although not free of complications, is a very safe procedure regardless of the extraction technique used.

Aged↗

PubMed1994

Functional status and quality of life measurement among ophthalmic patients.

OBJECTIVES: Assessment of the relationship between visual function and functional status/quality of life in clinical research involving patients with eye disease by investigating whether the scores of four existing functional status/quality of life patient questionnaires are sensitive to differences in visual acuity and studying whether selected subscales of the questionnaires provide similar information concerning the relationship between functional status/quality of life and visual acuity as do the respective full-length questionnaires. DESIGN, SETTING, PARTICIPANTS: Case patients consisted of 86 consecutive patients seen at The Wilmer Ophthalmological Institute Retinal Vascular Center, Baltimore, Md. Controls consisted of 51 individuals with normal visual acuity and no known ocular disease and were frequency-matched to the case patients by age (+/- 5 years), sex, and race. Subjects were interviewed in person using each of the following questionnaires: the Sickness Impact Profile, the vision-specific Sickness Impact Profile, the Community Disability Scale, and the General Health Questionnaire. RESULTS: Scores of all four questionnaires and their subscales were significantly associated with visual acuity. The vision-specific Sickness Impact Profile and the Community Disability Scale were independently significant predictors of visual acuity. Regression analysis revealed that in our study, selected subscales of the respective full-length questionnaires were able to demonstrate the association between vision and functional status/quality of life. CONCLUSIONS: Ophthalmic patients are at high risk for decreased functional status/quality of life. Subscales of existing questionnaires potentially may be substituted for the full-length questionnaires, thereby increasing the efficiency of functional status/quality of life measurement in such patients.

Aged↗

PubMed1994

The VF-14. An index of functional impairment in patients with cataract.

OBJECTIVE: To describe the development and the performance of a brief questionnaire designed to measure functional impairment caused by cataract (the VF-14). DESIGN: Observational cross-sectional study. Patients were recruited between July 15 and December 15, 1991. SETTING: Patients were recruited from the practices of 70 ophthalmologists, located in Columbus, Ohio (N = 21), St Louis, Mo (N = 26), and Houston, Tex (N = 23). PATIENTS: Seven hundred sixty-six patients undergoing cataract surgery for the first time. MAIN OUTCOME MEASURES: Preoperative best corrected visual acuity in each eye; scores on the VF-14, a new index of functional impairment in patients with cataract; patient reports of overall trouble and satisfaction with their vision; and scores on the Sickness Impact Profile, a measure of general health status. RESULTS: The VF-14 has high internal consistency (Cronbach's alpha = .85) and correlates more strongly with the overall self-rating of the amount of trouble and satisfaction patients have with their vision than do several measures of visual acuity or the Sickness Impact Profile score. The VF-14 score is moderately correlated with visual acuity in the better eye. CONCLUSIONS: The VF-14 is a reliable and valid measure of functional impairment caused by cataract and provides information not conveyed by visual acuity or a general measure of health status.

Cataract↗

PubMed1994

Variation in ophthalmic testing before cataract surgery. Results of a national survey of ophthalmologists.

Little information is available either for the clinical value of many ophthalmic tests performed preoperatively in the evaluation of patients for cataract surgery or for variation in ophthalmologists' use of such tests. To assess variation in ophthalmologists' use of ophthalmic tests, we conducted a national survey of American Academy of Ophthalmology members. Thirty-three percent, 17%, 37%, and 19% of the respondents reported that they "frequently" or "always" perform glare testing, contrast sensitivity testing, potential acuity measurement, and specular microscopy, respectively, in patients being considered for cataract surgery who have no history of eye disease other than cataract. In contrast, 27%, 54%, 24%, and 48% of respondents reported that they never perform each of these four tests in such patients. Two ophthalmologist characteristics--a surgical volume of greater than 200 cataract extractions per year and performance of surgery in an ambulatory surgical center or private office (as opposed to a hospital)--were independently associated with an increased probability of performing each of these four tests frequently or always. Ten percent or less of the respondents reported that they frequently or always perform electroretinography, visual evoked response testing, photography of fundus or anterior segment, B-scan ultrasonography, formal color vision testing, and formal visual field testing in such patients. Thus, there is considerable variation in ophthalmologists' use of glare testing, contrast sensitivity testing, potential acuity measurement, and specular microscopy. A small percentage of ophthalmologists may be overusing several other tests in the evaluation of patients being considered for cataract surgery.

Adult↗

PubMed1994

Variation in cataract surgery practice and clinical outcomes.

PURPOSE: To examine associations between surgical technique, patient and surgeon characteristics, and clinical outcomes of cataract surgery. METHODS: Seventy-five ophthalmologists were recruited from three cities based on a sampling scheme stratified by surgeon-reported annual volume of cataract surgery. Seven hundred seventy-two patients undergoing first eye cataract surgery were enrolled, with complete preoperative, perioperative, and 4-month postoperative clinical data on 717 patients (93%). RESULTS: Sixty-five percent of surgery was performed by phacoemulsification and 35% by standard extracapsular (ECCE) techniques. Performance of ECCE was associated with the presence of ocular comorbidity and 21 or more years in practice of the surgeon. Performance of phacoemulsification was associated with annual volume of cataract surgery, wherein high-volume (201-399 patients annually) and very high-volume (> 400 patients annually) surgeons had 3.7 and 3.9 times the likelihood of performing phacoemulsification compared with moderate-volume (51-200 cases annually) surgeons. The rates of intraoperative, perioperative, and 4-month postoperative adverse events and the amount of improvement in visual acuity did not differ either by surgical technique or volume stratum. The reported occurrence of posterior capsular opacification within 4 months of surgery was increased in the presence of cortical opacification, one city, and patients operated on by either high- or very high-volume surgeons. CONCLUSIONS: In this cohort, no difference in clinical outcomes, as measured by change in visual acuity or occurrence of postoperative adverse events (except for posterior capsular opacification), can be attributed to performance of phacoemulsification versus ECCE or to the reported annual volume of cataract surgery of the surgeon. Self-reported high and very high annual volume of cataract surgery is associated independently with performance of phacoemulsification and surgeon's report of posterior capsular opacification at 4 months after cataract surgery.

Aged↗

PubMed1994

National study of cataract surgery outcomes. Variation in 4-month postoperative outcomes as reflected in multiple outcome measures.

BACKGROUND: Although ophthalmologists have long recognized that visual acuity alone is an inadequate measure of visual impairment, the need for and outcomes of cataract surgery historically have been assessed in terms of visual acuity. PURPOSE: To examine the relation among different cataract surgery outcome measures, including a 14-item instrument designed to measure functional impairment caused by cataract (the VF-14), at 4 months after cataract surgery. METHODS: The authors performed a longitudinal study of 552 patients undergoing first eye cataract surgery by 1 of 75 ophthalmologists practicing in Columbus, Ohio, St. Louis, Missouri, or Houston, Texas. Patients were interviewed, and clinical data were obtained preoperatively (July 15, 1991-March 14, 1992) and 4 months postoperatively. RESULTS: The percentage of patients judged to be improved at 4 months after cataract surgery varied by the outcome measure used: Snellen visual acuity (96%); VF-14 score (89%); satisfaction with vision (85%); self-reported trouble with vision (80%); and Sickness Impact Profile score (67%). The change in patients' ratings of their trouble with vision and their satisfaction with vision were correlated more strongly with the change in VF-14 score than with the change in visual acuity (operated eye or better eye). The average change in VF-14 score was unrelated to the preoperative visual acuity in the eye undergoing surgery. CONCLUSION: Estimates of the proportion of patients benefiting from cataract surgery vary with the outcome measure used to measure benefit. Change in VF-14 score, a measure of functional impairment related to vision, may be a better measure of the benefit of cataract surgery than change in visual acuity.

Aged↗