Variation in ophthalmic testing prior to cataract surgery. Results of a national survey of optometrists. Cataract Patient Outcome Research Team
E. B. Bass, E. P. Steinberg, R. Luthra, O. D. Schein, J. Javitt, P. Sharkey, J. Tielsch, M. W. Legro, J. Kassalow and D. Steinwachs
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
OBJECTIVE: To assess variation in optometrists' use of ophthalmic tests in
the evaluation of patients being considered for cataract surgery who have
no history of other eye disease. DESIGN/PARTICIPANTS: National survey of a
systematic sample of practicing members of the American Optometric
Association (St Louis, Mo), who had referred at least one patient to an
ophthalmologist for consideration of cataract surgery in 1991. RESULTS:
Ninety-two of 130 eligible responding optometrists reported that they
routinely performed preoperative testing on patients being considered for
cataract surgery. Of these 92 optometrists, 91 (99%) frequently or always
performed refraction, and 82 (89%) frequently or always performed a dilated
fundus examination in their evaluation of patients being considered for
cataract surgery who had no history of other eye disease. None of these 92
optometrists reported using B-scan ultrasonography or electroretinograms
frequently or always, and few used A-scan ultrasonography or visual evoked
responses frequently or always. A substantial percentage frequently or
always used formal visual field testing (47%), formal color vision testing
(40%), fundus photography (24%), potential acuity measurement (25%), glare
testing (23%), contrast sensitivity testing (19%), and specular microscopy
(14%), while 11% to 81% of optometrists never performed these tests on such
patients. More recent graduation from optometry school was associated with
a decreased frequency of use of potential acuity measurement and contrast
sensitivity testing and with an increased use of dilated fundus
examinations. CONCLUSION: There is a substantial variation in optometrists
self-reported use of a number of ophthalmic tests in the preoperative
evaluation of patients being considered for cataract surgery who have no
history of other eye disease.
