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Focussing both eyes on health outcomes: revisiting cataract surgery Davis, Jennifer Colleen; McNeill, Heather; Wasdell, Michael; Chunick, Susan; Bryan, Stirling

Abstract

Background: The appropriateness of cataract surgery procedures has been questioned, the suggestion being that the surgery is sometimes undertaken too early in the disease progression. Our three study questions were: What is the level of visual impairment in patients scheduled for cataract surgery? What is the improvement following surgery? Given the thresholds for a minimal detectable change (MDC) and a minimal clinically important difference (MCID), do gains in visual function reach the MDC and MCID thresholds? Methods The sample included a prospective cohort of cataract surgery patients from four Fraser Health Authority ophthalmologists. Visual function (VF-14) was assessed pre-operatively and at seven weeks post-operatively. Two groups from this cohort were included in this analysis: ‘all first eyes’ (cataract extraction on first eye) and ‘both eyes’ (cataract removed from both eyes). Descriptive statistics, change scores for VF-14 for each eye group and proportion of patients who reach the MDC and MCID are reported. Results One hundred and forty-two patients are included in the ‘all first eyes’ analyses and 55 in the ‘both eyes’ analyses. The mean pre-operative VF-14 score for the ‘all first eyes’ group was 86.7 (on a 0–100 scale where 100 is full visual function). The mean change in VF-14 for the 'both eyes' group was 7.5. Twenty-three percent of patients achieved improvements in visual function beyond the MCID threshold and 35% saw improvement beyond the MDC. Conclusions Neither threshold level for MDC or MCID for the VF-14 scale was achieved for a majority of patients. A plausible explanation for this is the very high levels of pre-operative visual functioning.

Item Metadata

Title
Focussing both eyes on health outcomes: revisiting cataract surgery
Creator
Davis, Jennifer Colleen; McNeill, Heather; Wasdell, Michael; Chunick, Susan; Bryan, Stirling
Contributor
Centre for Clinical Epidemiology and Evaluation
Publisher
BioMed Central
Date Issued
2012-09-03
Description
Background: The appropriateness of cataract surgery procedures has been questioned, the suggestion being that the surgery is sometimes undertaken too early in the disease progression. Our three study questions were: What is the level of visual impairment in patients scheduled for cataract surgery? What is the improvement following surgery? Given the thresholds for a minimal detectable change (MDC) and a minimal clinically important difference (MCID), do gains in visual function reach the MDC and MCID thresholds? Methods The sample included a prospective cohort of cataract surgery patients from four Fraser Health Authority ophthalmologists. Visual function (VF-14) was assessed pre-operatively and at seven weeks post-operatively. Two groups from this cohort were included in this analysis: ‘all first eyes’ (cataract extraction on first eye) and ‘both eyes’ (cataract removed from both eyes). Descriptive statistics, change scores for VF-14 for each eye group and proportion of patients who reach the MDC and MCID are reported. Results One hundred and forty-two patients are included in the ‘all first eyes’ analyses and 55 in the ‘both eyes’ analyses. The mean pre-operative VF-14 score for the ‘all first eyes’ group was 86.7 (on a 0–100 scale where 100 is full visual function). The mean change in VF-14 for the 'both eyes' group was 7.5. Twenty-three percent of patients achieved improvements in visual function beyond the MCID threshold and 35% saw improvement beyond the MDC. Conclusions Neither threshold level for MDC or MCID for the VF-14 scale was achieved for a majority of patients. A plausible explanation for this is the very high levels of pre-operative visual functioning.
Subject
Cataract surgery; Visual function; Health outcomes
Genre
Article
Type
Text
Language
eng
Date Available
2015-12-16
Provider
Vancouver : University of British Columbia Library
Rights
Attribution 4.0 International (CC BY 4.0)
DOI
10.14288/1.0221351
URI
http://hdl.handle.net/2429/55831
Affiliation
Population and Public Health (SPPH), School of; Non UBC; Medicine, Faculty of
Citation
BMC Geriatrics. 2012 Sep 03;12(1):50
Publisher DOI
10.1186/1471-2318-12-50
Peer Review Status
Reviewed
Scholarly Level
Faculty
Copyright Holder
Davis et al.; licensee BioMed Central Ltd.
Rights URI
http://creativecommons.org/licenses/by/4.0/
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Attribution 4.0 International (CC BY 4.0)