Prediction of visual function after cataract surgery. A prospectively validated model
C. M. Mangione, E. J. Orav, M. G. Lawrence, R. S. Phillips, J. M. Seddon and L. Goldman
Division of Clinical Epidemiology, Brigham and Women's Hospital, Boston, Mass., USA.
OBJECTIVE: To develop a model to predict visual functional improvement
after cataract extraction with intraocular lens implantation based on
preoperative data. DESIGN: A prospective study with serial evaluations of
visual function preoperatively and at 3 and 12 months after surgery.
SETTING: The General Eye Service of the Massachusetts Eye and Ear
Infirmary. Boston, Mass, and 33 ophthalmology practices in Boston.
PATIENTS: Patients (N = 426; ages, > or = 65 years) who were undergoing
cataract surgery. METHODS: Twelve-month improvement in visual function was
measured by using the Activities of Daily Vision Scale (ADVS). Ordinal
logistic regression was used to identify correlates of improved ADVS scores
in 281 patients (derivative set). Potential factors included the
preoperative visual acuity, preoperative ADVS score, four chronic ocular
diseases, eight medical conditions, and demographic characteristics. Five
predictors were identified and used to construct a prediction rule. The
accuracy of the prediction rule was evaluated in an independent group of
145 patients (validation set). RESULTS: Postoperatively, 40% of the 281
patients in the derivative set had substantial improvement in their ADVS
scores, and 53 (19%) had some improvement. Predictors of improvement
included younger age (P < .001), a poorer preoperative ADVS score (P
< .001), posterior subcapsular cataract (P = .09), and absence of
age-related cataract (P = .09), and absence of age-related macular
degeneration (P = .07) and/or diabetes (P = .006). When applied to the
independent sample of 145 patients, these five characteristics classified
the patients into three groups in which the probabilities of substantial
improvement were 85%, 34%, and 3%, thus verifying the discriminatory power
of the prediction rule. CONCLUSIONS: Preoperative data can identify
patients who are likely to have improvements in visual function after
cataract surgery. Such findings may be useful in the selection of patients
for this high-volume procedure.
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