Outcomes/Effectiveness Research

Despite international treatment variations in cataract management, optimal vision is the usual patient outcome

The United States, Canada, Denmark, and Spain have different approaches to cataract management. The countries vary in their organization of care, preoperative testing, choice of anesthetic and surgical techniques, indications for surgery, and complication rates. Yet these treatment variations do not affect the odds of achieving an optimal visual outcome, according to findings from the International Cataract Surgery Outcomes Study. These results indicate that high-quality cataract management is performed in all four countries.

The researchers, who were supported in part by the Agency for Healthcare Research and Quality (HS07085), collected clinical data and patient interview data preoperatively and 4 months postoperatively from cataract surgery patients in the four countries. They assessed functional outcomes using the Visual Function Index (VF-14), with scores ranging from 0 (maximum impairment) to 100 (no impairment). This index reflects the patient's reported ability to perform vision-related tasks such as sewing, reading, shopping, and driving. Of patients undergoing cataract surgery on one eye, the odds of achieving an optimal visual outcome (VF-14 score of 95 or more) were similar among sites, after controlling for differences in patients.

Among the 211 patients who had cataract surgery on both eyes, 155 patients reported an optimal postoperative visual acuity score of 0.50 or better in both eyes on the Snellen visual acuity test (the patient reads letters from a chart at a certain distance). However, 37 percent of these patients reported visual function impairment (VF-14 score less than 95). These results imply that a VF-14 score, which can be scored in 10 minutes, can identify patients who still have visual function impairments despite what might seem an optimal anatomic outcome. The researchers suggest that changes in visual function as well as changes in visual acuity be reported in any study evaluating the benefits of cataract surgery.

See "Visual functional outcomes of cataract surgery in the United States, Canada, Denmark, and Spain," by Jens Christian Norregaard, M.D., Ph.D., Peter Bernth-Petersen, M.D., Ph.D., Jordi Alonso, M.D., Ph.D., and others, in the November 2003 Journal of Cataract Refractive Surgery 29, pp. 2135-2142.

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