Variation in ophthalmic testing before cataract surgery. Results of a national survey of ophthalmologists
E. P. Steinberg, E. B. Bass, R. Luthra, O. D. Schein, P. Sharkey, J. Javitt, J. Tielsch, M. Kolb and D. Steinwachs
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
Little information is available either for the clinical value of many
ophthalmic tests performed preoperatively in the evaluation of patients for
cataract surgery or for variation in ophthalmologists' use of such tests.
To assess variation in ophthalmologists' use of ophthalmic tests, we
conducted a national survey of American Academy of Ophthalmology members.
Thirty-three percent, 17%, 37%, and 19% of the respondents reported that
they "frequently" or "always" perform glare testing, contrast sensitivity
testing, potential acuity measurement, and specular microscopy,
respectively, in patients being considered for cataract surgery who have no
history of eye disease other than cataract. In contrast, 27%, 54%, 24%, and
48% of respondents reported that they never perform each of these four
tests in such patients. Two ophthalmologist characteristics--a surgical
volume of greater than 200 cataract extractions per year and performance of
surgery in an ambulatory surgical center or private office (as opposed to a
hospital)--were independently associated with an increased probability of
performing each of these four tests frequently or always. Ten percent or
less of the respondents reported that they frequently or always perform
electroretinography, visual evoked response testing, photography of fundus
or anterior segment, B-scan ultrasonography, formal color vision testing,
and formal visual field testing in such patients. Thus, there is
considerable variation in ophthalmologists' use of glare testing, contrast
sensitivity testing, potential acuity measurement, and specular microscopy.
A small percentage of ophthalmologists may be overusing several other tests
in the evaluation of patients being considered for cataract surgery.
