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Ontario Cataract Quality Outcome Initiative: appropriateness and prioritization of cataract surgery

  • Wendy V. Hatch
    Correspondence
    Correspondence to Wendy Hatch OD MSc, Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON M5T3A9, Canada.
    Affiliations
    Kensington Eye Institute, Toronto, Ont.

    Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Que.
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  • Victoria Leung
    Affiliations
    Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Que.
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  • Iqbal Ahmed
    Affiliations
    Kensington Eye Institute, Toronto, Ont.

    Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Que.

    Prism Eye Institute, Brampton, Ont.
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  • Matthew Schlenker
    Affiliations
    Kensington Eye Institute, Toronto, Ont.

    Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Que.

    Prism Eye Institute, Brampton, Ont.
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  • Negar Babaei Omali
    Affiliations
    Kensington Eye Institute, Toronto, Ont.
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  • Karen Pope
    Affiliations
    Unity Health Toronto, St. Michael's Hospital, Toronto, Ont.
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  • Gerald Lebovic
    Affiliations
    Unity Health Toronto, St. Michael's Hospital, Toronto, Ont.

    Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ont.
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  • Kylen McReelis
    Affiliations
    Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Que.

    Department of Ophthalmology, Peterborough Regional Health Centre, Peterborough, Ont.
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  • Walter Delpero
    Affiliations
    Department of Ophthalmology, University of Ottawa, Ottawa, Ont.
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  • Robert J. Campbell
    Affiliations
    Department of Ophthalmology, Queen's University, Kingston, Ont.

    Department of Ophthalmology, Kingston Health Sciences Centre, Kingston, Ont.

    Scientist, Institute for Clinical Evaluative Sciences, Toronto, Ont.
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  • Cataract Quality Outcome Initiative (CQOI) Working Group
    Author Footnotes
    2 CQOI Working Group: John Gorfinkel, MD, Cindy Lam, MD, Amandeep Rai, MD, Jennifer Calafati, MD, Larissa Derzko-Dzulynsky, MD, Tom Klein, MD, Devesh Varma, MD, Diomond Tam, MD, Joshua Teichman, MD, MSc, George Mintsioulis, MD, Setareh Ziai, MD
  • Sherif El Defrawy
    Affiliations
    Kensington Eye Institute, Toronto, Ont.

    Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Que.
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  • Author Footnotes
    2 CQOI Working Group: John Gorfinkel, MD, Cindy Lam, MD, Amandeep Rai, MD, Jennifer Calafati, MD, Larissa Derzko-Dzulynsky, MD, Tom Klein, MD, Devesh Varma, MD, Diomond Tam, MD, Joshua Teichman, MD, MSc, George Mintsioulis, MD, Setareh Ziai, MD

      Abstract

      Objective

      To explore the utility of the Catquest 9SF visual function (VF) questionnaire along with visual acuity (VA) for determining appropriateness and priority for cataract surgery. To evaluate the feasibility of administering the Catquest-9SF in a clinical setting using web-based electronic data capture and interpretation.

      Design

      Prospective multicentred interventional observational study.

      Participants

      Subjects undergoing sequential cataract surgery in both eyes at 4 sites in Ontario.

      Methods

      We recorded best-corrected VA (BCVA) and VA with current correction (CCVA) in each eye and both eyes (OU) and Catquest-9SF responses on a tablet before and after cataract surgery. Linear regression models were employed to test for associations between VA and visual function (VF).

      Results

      Preoperative BCVA and CCVA in the worse eye were significant predictors of change in VF (p = 0.006 and p = 0.008, respectively); subjects with worse VA had a greater improvement in VF after surgery. There was a significant association between improvement in VF and improvement in CCVA OU (p = 0.001). Fourteen of 151 subjects (9%) had no improvement or worse VF scores after surgery. Within this group, 10 of 14 subjects had a preoperative score ≤–3, which is suggestive of minimal visual disability. Within this subset, 4 of 14 subjects (2.6%) had a preoperative BCVA of 20/30 or better in their worse eye.

      Conclusions

      For patient groups with equal VA, the Catquest-9SF score can help determine priority for surgery. Web-based data capture and interpretation allow for efficient virtual assessments of VF. A BCVA in the worse eye of 20/30 or better combined with a Catquest-9SF score <–3 can be used as a guideline for lowest priority.
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