Cataract surgery at the Vancouver Eye Care Centre: do patient indications meet provincial clinical practice guidelines?
BACKGROUND
Cataract surgery, already the most common elective surgical procedure among patients over the age of 65 in North America, is rising in volume, because the population is aging while at the same time holding growing expectations of continued vitality. In meeting the need, there is a public interest in ensuring that cataract surgery is used appropriately. The purpose of this paper was to investigate the indication for cataract surgery performed in adults at a large tertiary care centre in Vancouver and to determine the extent to which patient criteria met the guidelines of the College of Physicians & Surgeons of British Columbia.


METHODS
Patients attending the centre were enrolled in the cataract outcome assessment program through systematic sampling that included every patient with a personal health card number ending in 5 or 8 (20% of patients). There were no patient exclusion criteria. Pre-, intra- and postoperative clinical information was collected from patients' medical records. Patients were also sent a pre- and postoperative visual function and quality-of-life questionnaire.


RESULTS
A total of 1098 cataract surgery procedures were performed in 896 patients from March 1999 to December 2000. The average age of the patients was 72.9 years; most (69.5%) were women. Just over half of the procedures (620 [56.6%]) were performed as first-eye surgery. In 191 cases (17.9%) the preoperative visual acuity was 20/40 or better in the affected eye. In most cases (82.1%) visual acuity of 20/50 or worse was the indication for surgery. In 89 cases (8.3%) there was not enough information in the chart to justify the surgery.


CONCLUSIONS
By examining standard information provided in patients' medical records, we were able to determine the indication for cataract surgery in 92% of cases. The most common indication was poor visual acuity.
B.C. Centre for Epidemiologic and International Ophthalmology, University of British Columbia, Vancouver, BC.
Drew
D
Mildon
Kukuh
K
Noertjojo
David
D
Rollins
Jeffrey
J
Blicker
Francis
F
Law
Paul
P
Courtright
Ken
K
Bassett
D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia; D002386:Cataract / Q000175:diagnosis; D002387:Cataract Extraction / Q000592:standards*; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic / Q000592:standards*; D011788:Quality of Life; D012189:Retrospective Studies; D013219:State Government; D011795:Surveys and Questionnaires; D014786:Vision Disorders / Q000175:diagnosis; D014792:Visual Acuity