International variation in ophthalmologic management of patients with cataracts. Results from the International Cataract Surgery Outcomes Study
J. C. Norregaard, O. D. Schein, G. F. Anderson, J. Alonso, E. Dunn, C. Black, T. F. Andersen, P. Bernth-Petersen, L. Bellan and M. Espallargues
Department of Social Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark.
OBJECTIVES: To describe international variation in the management of
patients with cataacts in 4 health care systems and to discuss the
potential implications for cost and utilization of services. DESIGN: To
characterize current clinical practice on patients with no coexisting
medical or ocular conditions, a standardized questionnaire was sent to
random samples of ophthalmologists in the United States (response rate,
82.5%), Canada (66.9%), and Barcelona, Spain (70.4%), and to all
ophthalmologists in Denmark (80.1%). From the United States, 526
ophthalmologists who performed cataract surgery participated in the study;
there were 276 from Canada, 89 from Barcelona, and 82 from Denmark.
RESULTS: Although in all 4 sites most surgeons reported that they performed
A-scanning, fundus examination, and refraction routinely before surgery,
significant crossnational variation was observed in preoperative ophthalmic
and medical testing. While preoperative medical tests were virtually unused
in Denmark, they were widely used in the other sites. A significantly
higher proportion of the surgeons in the United States and Barcelona
reported that they performed less than 100 extractions per year compared
with surgeons in Canada and Denmark (P < .001). A significantly higher
proportion of the surgeons in the United States and Canada were performing
predominantly phacoextraction compared with surgeons in Denmark and
Barcelona (P < .001). Both within and across sites, considerable
variation in number of follow-up visits and postoperative tests was
observed. CONCLUSIONS: Significant international variation in the
management of healthy patients with cataracts has been observed. If less
intensive care is not associated with poorer outcomes, there is the
potential for less costly care of patients with cataracts. Further research
identifying the most cost-effective practices is needed.
