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. 1998 Oct;82(10):1107–1111. doi: 10.1136/bjo.82.10.1107

Variation in indications for cataract surgery in the United States, Denmark, Canada, and Spain: results from the International Cataract Surgery Outcomes Study

J C Norregaard 1, P Bernth-Petersen 1, J Alonso 1, E Dunn 1, C Black 1, T F Andersen 1, M Espallargues 1, L Bellan 1, G Anderson 1
PMCID: PMC1722378  PMID: 9924294

Abstract

BACKGROUND/AIMS—International comparisons of clinical practice may help in assessing the magnitude and possible causes of variation in cross national healthcare utilisation. With this aim, the indications for cataract surgery in the United States, Denmark, the province of Manitoba (Canada), and the city of Barcelona (Spain) were compared.
METHODS—In a prospective multicentre study, patients scheduled for first eye cataract surgery and aged 50 years or older were enrolled consecutively. From the United States 766 patients were enrolled; from Denmark 291; from Manitoba 152; and from Barcelona 200. Indication for surgery was measured as preoperative visual status of patients enlisted for cataract surgery. Main variables were preoperative visual acuity in operative eye, the VF-14 score (an index of functional impairment in patients with cataract) and ocular comorbidity.
RESULTS—Mean visual acuity were 0.23 (USA), 0.17 (Denmark), 0.15 (Manitoba), and 0.07 (Barcelona) (p<0.001). When restricting the sample to eyes with normal retina and macula, no significant difference between United States and Denmark was observed (p>0.05). Mean VF-14 scores were 76 (USA), 76 (Denmark), 71 (Manitoba), and 64 (Barcelona) (p<0.001).
CONCLUSION—Similar indications for cataract surgery were found in the United States and Denmark. Significantly more restricted indications were observed in Manitoba and Barcelona. Possible explanations for the results are discussed, including differences in sociodemographic characteristics, access to care, surgeons' willingness to operate, and patient demand.

 Keywords: cataract surgery; North America; Europe

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Selected References

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  1. Alonso J., Espallargues M., Andersen T. F., Cassard S. D., Dunn E., Bernth-Petersen P., Norregaard J. C., Black C., Steinberg E. P., Anderson G. F. International applicability of the VF-14. An index of visual function in patients with cataracts. Ophthalmology. 1997 May;104(5):799–807. doi: 10.1016/s0161-6420(97)30230-9. [DOI] [PubMed] [Google Scholar]
  2. Anderson G. F., Alonso J., Kohn L. T., Black C. Analyzing health outcomes through international comparisons. Med Care. 1994 May;32(5):526–534. doi: 10.1097/00005650-199405000-00010. [DOI] [PubMed] [Google Scholar]
  3. Badía X., Alonso J. Validity and reproducibility of the Spanish Version of the Sickness Impact Profile. J Clin Epidemiol. 1996 Mar;49(3):359–365. doi: 10.1016/0895-4356(95)00038-0. [DOI] [PubMed] [Google Scholar]
  4. Bergner M., Bobbitt R. A., Carter W. B., Gilson B. S. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981 Aug;19(8):787–805. doi: 10.1097/00005650-198108000-00001. [DOI] [PubMed] [Google Scholar]
  5. Bernth-Petersen P., Bach E. Epidemiologic aspects of cataract surgery. II: Regional variation in frequencies. Acta Ophthalmol (Copenh) 1983 Jun;61(3):397–405. doi: 10.1111/j.1755-3768.1983.tb01438.x. [DOI] [PubMed] [Google Scholar]
  6. Cassard S. D., Patrick D. L., Damiano A. M., Legro M. W., Tielsch J. M., Diener-West M., Schein O. D., Javitt J. C., Bass E. B., Steinberg E. P. Reproducibility and responsiveness of the VF-14. An index of functional impairment in patients with cataracts. Arch Ophthalmol. 1995 Dec;113(12):1508–1513. doi: 10.1001/archopht.1995.01100120038005. [DOI] [PubMed] [Google Scholar]
  7. Desai P. The National Cataract Surgery Survey: III. Process features. Eye (Lond) 1993;7(Pt 5):667–671. doi: 10.1038/eye.1993.153. [DOI] [PubMed] [Google Scholar]
  8. Escarce J. J. Would eliminating differences in physician practice style reduce geographic variations in cataract surgery rates? Med Care. 1993 Dec;31(12):1106–1118. doi: 10.1097/00005650-199312000-00004. [DOI] [PubMed] [Google Scholar]
  9. Javitt J. C., Kendix M., Tielsch J. M., Steinwachs D. M., Schein O. D., Kolb M. M., Steinberg E. P. Geographic variation in utilization of cataract surgery. Med Care. 1995 Jan;33(1):90–105. doi: 10.1097/00005650-199501000-00008. [DOI] [PubMed] [Google Scholar]
  10. Moseley M. J., Jones H. S. Visual acuity: calculating appropriate averages. Acta Ophthalmol (Copenh) 1993 Jun;71(3):296–300. doi: 10.1111/j.1755-3768.1993.tb07138.x. [DOI] [PubMed] [Google Scholar]
  11. Nørregaard J. C., Bernth-Petersen P., Andersen T. F. Visual impairment and general health among Danish cataract patients. Results from the Danish Cataract Surgery Outcomes Study. I. Acta Ophthalmol Scand. 1996 Dec;74(6):598–603. doi: 10.1111/j.1600-0420.1996.tb00743.x. [DOI] [PubMed] [Google Scholar]
  12. Schein O. D., Steinberg E. P., Javitt J. C., Cassard S. D., Tielsch J. M., Steinwachs D. M., Legro M. W., Diener-West M., Sommer A. Variation in cataract surgery practice and clinical outcomes. Ophthalmology. 1994 Jun;101(6):1142–1152. doi: 10.1016/s0161-6420(94)31209-7. [DOI] [PubMed] [Google Scholar]
  13. Steinberg E. P., Tielsch J. M., Schein O. D., Javitt J. C., Sharkey P., Cassard S. D., Legro M. W., Diener-West M., Bass E. B., Damiano A. M. The VF-14. An index of functional impairment in patients with cataract. Arch Ophthalmol. 1994 May;112(5):630–638. doi: 10.1001/archopht.1994.01090170074026. [DOI] [PubMed] [Google Scholar]
  14. de Bruin A. F., de Witte L. P., Stevens F., Diederiks J. P. Sickness Impact Profile: the state of the art of a generic functional status measure. Soc Sci Med. 1992 Oct;35(8):1003–1014. doi: 10.1016/0277-9536(92)90240-q. [DOI] [PubMed] [Google Scholar]

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