Cataract surgery benchmarks proposed

Physicians around the world should begin tabulating their results according to common standards, an international committee has proposed.

“To compare outcomes between countries and thereby learn and improve processes, a common data set with common definitions is needed,” writes the committee of International Consortium for Health Outcomes Measurement (ICHOM).

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The committee’s members include representatives of organizations already involved in collecting data on cataracts in Sweden, the United Kingdom,

Australia, India, Malaysia and the United States. They published their recommendations August 20 in JAMA Ophthalmology.

Many countries have already established registries of cataract surgery outcomes.

Among such past and present registries are the Swedish National Cataract Register, the European Registry of Quality Outcomes for Cataract and Refractive Surgery, the United Kingdom’s Cataract National Data Set, the Malaysian National Eye Database, the National Eye Outcomes Network in the United States, and the Aravind Cataract Registry in India.

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The ICHOM standards include two dozen points that could be used to evaluate the success of phacoemulsification, sutured manual extracapsular cataract extraction, sutureless manual extracapsular cataract extraction, and intracapsular cataract extraction.

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Doctors, patients or administrators would gather information about the patients’ demographics, ocular history and comorbidities, preoperative visual acuity, and patient-reported visual function prior to surgery.

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They would report capsule-related problems, dislocation of lens nucleus fragments into the vitreous, and other complications that occur during surgery.

And they would note refractive error, patient-reported visual function, and early and late complications for up to 3 months after surgery.

In an editorial accompany the study, Bonnie An Henderson, MD, of Tufts University School of Medicine in Boston, Massachusetts, commended the authors.

The new standards could be useful for payers and patients who want to more accurately rank physicians, she wrote. Already many insurance companies use limited data, such as the cost of care, to create tiered provider plans. If they had more complete data, they could evaluate physicians more appropriately, she said.

In addition, Dr. Henderson said, training programs could use the standards to evaluate how well they are preparing ophthalmologists to do cataract surgery. Likewise, residency programs would be able to compare applications from prospective residents trained abroad to those from residents trained domestically.

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Finally, said Dr. Henderson, researchers could more easily gather large data sets to study diseases and treatments. This might be particularly useful for rare disease such as endophthalmitis, she said.

Next: Importance of collaboration

“In today’s global world, collaboration between countries to create a universal set of guidelines is an honourable pursuit,” Dr Henderson concludes.

The ICHOM committee suggested an additional way the data could be used: as part of an approval process for devices used in cataract surgery.

ICHOM selected the working group members based on their prior experience with outcomes measurement in cataract surgery or involvement in clinical registries. The group included ophthalmologists, an optometrist, an executive at an eye hospital, and a patient advocate who had recently undergone cataract surgery.

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The committee called its list of standards “a minimum data set,” noting that there was nothing to stop anyone from collecting additional information. The committee tried to come up with standards that were practical to collect as well as comprehensive enough to be useful.  

“We believe that this data set builds on existing national registries by aligning the metrics used across a larger scale and steering data collection efforts toward outcomes that matter most to patients,” the committee concludes.