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Improving results of cataract surgery by looking at outcomes important to patients

Special issue of focuses on patient-reported outcome measures

can lead to good results from a clinical standpoint yet have poor outcomes from the patient’s point of view, reports a study, “Analyzing Patient-Reported Outcomes to Improve Cataract Care”, appearing in the August issue of Optometry and Vision Science, official journal of the American Academy of Optometry. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Using well-designed and validated tools to assess patient-reported outcomes can lead to new insights for improving the results of cataract care, suggests the study by Mats Lundström, MD, PhD, of Lund University and Ulf Stenevi, MD, PhD, of Sahlgren’s University Hospital, Sweden. Their paper is part of a special theme issue on “Measuring the Patient’s Perspective” in optometry research and clinical practice.

Study Compares Clinical and Patient-Reported Outcomes of Cataract Surgery

Using a nationwide registry, Drs Lundström and Stenevi evaluated clinical and patient-reported outcome measures in nearly 10,000 cataract surgeries performed in Sweden between 2001 and 2011. For example, a major clinical outcome measure after cataract surgery is visual acuity. But improved visual acuity may not always reflect patient ratings of change in vision from before to after the procedure – especially in performing everyday functional tasks.

Not surprisingly, a comparison of the two sets of outcomes found that patient-reported measures were affected by clinical measures. Factors affecting patient-reported outcomes included visual acuity in both the operated and nonoperated eyes, change in visual acuity in the operated eye, and any other eye-related conditions (“ocular comorbidity”).

However, more useful information was gained by looking at factors related to better or worse patient-reported outcomes. For example, patients who reported better visual function before surgery or who had poor visual acuity in the nonoperated eye were more likely to have poorer patient-reported outcomes after cataract surgery.

Implications for Decisions about Cataract Care

Ocular comorbidity was also related to worse patient-reported outcomes. These findings may indicate that, as in other chronic diseases, “some patients are too healthy and some too sick to benefit” from cataract surgery, Drs Lundström and Stenevi write. “It is possible that patients who are very satisfied with their vision and have no problems in performing daily life activities should not have cataract surgery at present.”

The study also looked at situations where the clinical outcomes were good but patient-reported outcomes were poor – which happened in about seven percent of cataract surgeries. In many of these cases, poor near vision after the procedure was a major contributor to patient dissatisfaction.

There’s a growing emphasis on patient-reported outcomes and quality of life in assessing various medical or surgical treatments. But there’s been little attention to linking patient-reported outcomes to clinical outcomes in an attempt to improve health care. Age-related cataract is a good model for quality outcome studies: it is a very common, progressive condition that affects daily life and activities, and one for which surgical treatment is effective.

The new study helps vision care professionals in understanding how patient-reported outcome measures might be used to improve on the results of cataract surgery from the patient’s perspective. For example, Drs Lundström and Stenevi suggest that surgery could be delayed or not performed in patients who feel they aren’t having a lot of problems with daily activities – perhaps especially if they have good near vision.

The special theme issue presents 20 papers on topics related to the use of patient-reported outcomes in vision care. “These papers focus on new tools that are being increasingly used to assess the patient’s perspective on a wide range of important conditions, problems, and outcomes,” comments Anthony Adams, OD, PhD, Editor-in-Chief of Optometry and Vision Science. “These measures allow us to rigorously measure the outcomes important to patients, and to do so in a very meaningful way.”


Optometry & Vision Science: August 2013 – Volume 90 – Issue 8 – p 754-759

Lundström, Mats*; Stenevi, Ulf*

Abstract – Analyzing Patient-Reported Outcomes to Improve Cataract Care

Purpose: The purpose of this study was to analyze three models of how patient-reported outcome measures can be connected to clinical outcome measures in cataract surgery to identify opportunities for improvement of quality of care.

Methods: Three models were used to analyze the following questions: Is there a relationship between clinical parameters and patient-reported outcomes? (1) Is there a relationship between clinical parameters and a good or poor patient-reported outcome? (2) When and why do clinical and patient-reported outcomes diverge? (3) The study material to exemplify these models consisted of follow-up data on cataract extractions collected by the Swedish National Cataract Register in 2008 to 2011. Patient-reported outcome was measured using the Catquest-9SF questionnaire. A total of 9707 pairs of questionnaires completed before and after a cataract extraction were analyzed together with clinical data.

Results: Factors related to any change in patient-reported outcomes after surgery were the preoperative self-assessed visual function, the preoperative visual acuity in both eyes, the postoperative visual acuity, and ocular comorbidity. Factors related to poor patient-reported outcomes after surgery were good preoperative self-assessed visual functions, poor preoperative visual acuity in the better eye, ocular comorbidity, surgical complications, and large refractive deviation. Poor near vision after surgery was the main factor noted in situations where the clinical outcome was good and the patient-reported outcome was poor. Analyses 2 and 3 were the most useful analyses to give ideas for clinical improvement work.

Conclusions: The best models to give ideas for improved quality of care by using a patient questionnaire in our study were analyzing the risk factors for a poor patient-reported outcome and analyzing the factors associated with disagreement between clinical outcomes and patient-reported outcomes.

Wolters Kluwer Health