Appropriateness Ratings in Cataract Surgery

ABSTRACT

This study aimed to evaluate the appropriateness of cataract surgery and identify the characteristics of patients and surgeons, clinical and functional outcomes, and surgical methods associated with appropriate cataract surgery. For this purpose, Korean cases of cataract surgery were rated as either 'necessity', 'appropriate', 'uncertain' or 'inappropriate', based on RAND/UCLA Ratings. For this assessment, the cases of 222 patients who underwent cataract surgery, on either one or both eyes, were studied. The surgeries were performed by 20 ophthalmologists practicing at one of fourteen medical institutions (university hospitals and general hospitals). Patients were interviewed and clinical data collected. The Doctors were questioned with self-entered questionnaire forms. The medical records were also examined to gain an understanding of the surgical process. The ratings were as follows 30.6% (68 patients) of surgeries belonged to the bracket "necessity", 46.4% (103 patients) to "appropriate", 15.3% (34 patients) to "uncertain" and 7.7% (17 patients) to "inappropriate". In this study, "necessity" and "appropriate" were defined as "appropriate" (77.0%, 171 patients), and "uncertain" and "inappropriate" as "inappropriate" (23.0%, 51 patients). The low preoperative Snellen visual acuity and visual function, advanced age and male patients were associated with appropriate surgery. It is concluded that appropriate surgery was related to the clinical and functional outcomes (visual acuity and visual function) and patient characteristics (age and male).