Preoperative testing practice in healthy cataract surgery patients. Results of a survey of ophthalmologists in Barcelona, Spain. Barcelona I-PORT Investigators

Use of vision tests in clinical decision making about cataract surgery: results of a national survey

AIM

To provide information on the use of vision tests in clinical decision making about cataract surgery in the UK.

METHOD

A questionnaire survey was mailed to 703 consultant ophthalmologists.

RESULTS

A response rate of 70% was obtained. Monocular distance visual acuity was the only visual function that was tested routinely by all surgeons. Supplementary use of contrast sensitivity and glare testing was low. Many surgeons (35%) were willing to consider surgery at acuity levels better than 6/9 and a small but substantial number (12%) indicated that they did not use an acuity criterion. Being prepared to consider surgery at relatively good levels of acuity was not associated with more common use of other tests of vision.

CONCLUSION

Many UK surgeons are prepared to consider cataract extraction at relatively good levels of visual acuity and use other vision tests infrequently.

Effectiveness of cataract surgery in Barcelona, Spain site results of an international study. Barcelona I-PORT investigators. International Patient Outcomes Research Team

OBJECTIVES

To describe the impact of cataract surgery on visual function and health status in terms of clinical indicators as well as perceived health and functional capacity, and to identify patient characteristics and differences in clinical management that might affect outcomes.

SUBJECTS AND METHODS

Observational longitudinal study of a cohort of 218 patients aged 50 or older undergoing first eye cataract surgery. Patients were evaluated pre- and postoperatively by clinical examinations (visual acuity [VA], ocular and medical comorbidity) and standardized telephone interviews. Main outcome measures included: the VF-14 Visual Function Index, the Cataract Symptom Score (CSS), the Sickness Impact Profile (SIP), and global measures of patients' trouble and satisfaction with vision.

RESULTS

Significant improvement in all outcomes measures were observed at 4 months postoperatively (P < 0.001). However, the proportion of improved patients varied according to the outcome considered: VA (87%), CSS (72%), VF-14 (62%), and SIP (38%). Patient characteristics associated with higher a level of improvement were: worse preoperative visual function (VA, CSS, VF-14) (P < 0.001), less ocular comorbidity (P < 0.05), less postoperative complications (P < 0.05) and better preoperative general health status (SIP) (P < 0.01). The differences in clinical management were not associated with the outcomes (effectiveness) of surgery.

CONCLUSIONS

A large proportion of patients benefit from cataract surgery, the greatest gain corresponding to visual function rather than to general health status. Since effectiveness of surgery is unrelated to operative procedures, less costly practices (i.e., day case surgery and loco-regional anesthesia) should be promoted.