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Report From the International Cataract Surgery Outcomes Study

Jens Christian Norregaard, MD, PhD; Charlotte Hindsberger, MSc; Jordi Alonso, MD, PhD; Lorne Bellan, MD; Peter Bernth-Petersen, MD, PhD; Charlyn Black, MD, ScD; Elaine Dunn, MA; Tavs Folmer Andersen, MSc, PhD; Mireia Espallargues, MD; Gerard F. Anderson, PhD

Arch Ophthalmol. 1998;116:1095-1100.

Objective  To compare visual outcomes obtained following cataract surgery in 4 sites in North America and Europe where considerable differences in the organization of care and patterns of clinical practice have been previously described.

Methods  Patients scheduled for first eye-cataract surgery and aged 50 years or older were enrolled consecutively in a prospective multicenter study that collected clinical and patient interview data preoperatively and postoperatively. From the United States, 772 patients were enrolled; from the Province of Manitoba (Canada), 159; from Denmark, 291; and from the City of Barcelona (Spain), 200. Preoperative and 4-month postoperative visual acuity was obtained for 92% of the patients (n=1291).

Results  The mean 4-month postoperative visual acuity of eyes operated on varied significantly across the 4 sites (P<.001) and had the following Snellen decimal fraction measurements: 0.49 in Barcelona, 0.65 in Denmark, 0.66 in Manitoba, and 0.74 in the United States. However, while crude visual acuity outcome figures varied significantly, no significant difference was observed across the 4 sites regarding the risk of poorer visual outcome after controlling for differences in age, preoperative visual acuity, and general health status for patients with no ocular comorbidity. Older age, poorer preoperative visual acuity, poorer preoperative general health status, and coexisting ocular comorbidity were predictors of a poorer visual outcome.

Conclusion  A previously identified variation in treatment modalities across the 4 sites did not seem to affect patients' visual acuity outcomes.

From the Institute of Public Health (Drs Norregaard and Andersen) and the Department of Biostatistics (Ms Hindsberger), Faculty of Health Science, University of Copenhagen, and Department of Ophthalmology, Hvidovre University Hospital (Drs Norregaard and Bernth-Petersen), Copenhagen, Denmark; Health Services Research Unit, Institut Municipal d'Investigació Mèdica (IMIM), Barcelona, Spain (Drs Alonso and Espallargues); Departments of Ophthalmology (Dr Bellan) and Community Health Sciences (Dr Black and Ms Dunn), Faculty of Medicine, and Manitoba Center for Health Policy and Evaluation (Dr Black), University of Manitoba, and Health Sciences Clinical Research Centre (Ms Dunn), Winnipeg, Canada; and Department of Health Policy and Management, Johns Hopkins University, Baltimore, Md (Dr Anderson).

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