Explicit criteria for prioritization of cataract surgery.
BACKGROUND
Consensus techniques have been used previously to create explicit criteria to prioritize cataract extraction; however, the appropriateness of the intervention was not included explicitly in previous studies. We developed a prioritization tool for cataract extraction according to the RAND method.


METHODS
Criteria were developed using a modified Delphi panel judgment process. A panel of 11 ophthalmologists was assembled. Ratings were analyzed regarding the level of agreement among panelists. We studied the effect of all variables on the final panel score using general linear and logistic regression models. Priority scoring systems were developed by means of optimal scaling and general linear models. The explicit criteria developed were summarized by means of regression tree analysis.


RESULTS
Eight variables were considered to create the indications. Of the 310 indications that the panel evaluated, 22.6% were considered high priority, 52.3% intermediate priority, and 25.2% low priority. Agreement was reached for 31.9% of the indications and disagreement for 0.3%. Logistic regression and general linear models showed that the preoperative visual acuity of the cataractous eye, visual function, and anticipated visual acuity postoperatively were the most influential variables. Alternative and simple scoring systems were obtained by optimal scaling and general linear models where the previous variables were also the most important. The decision tree also shows the importance of the previous variables and the appropriateness of the intervention.


CONCLUSIONS
Our results showed acceptable validity as an evaluation and management tool for prioritizing cataract extraction. It also provides easy algorithms for use in clinical practice.
Ma Quintana
José
J
Unidad de Investigación, Hospital de Galdakao, Barrio Labeaga s/n, 48960 Galdakao, Vizcaya, Spain. jmquinta@hgda.osakidetza.net
Escobar
Antonio
A
Bilbao
Amaia
A
D000203:Activities of Daily Living; D000465:Algorithms; D002386:Cataract / Q000145:classification / Q000175:diagnosis* / Q000473:pathology; D002387:Cataract Extraction / Q000592:standards*; D002985:Clinical Protocols; D000075202:Contraindications; D003663:Decision Trees; D003697:Delphi Technique; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000601:surgery; D006292:Health Priorities; D006801:Humans; D016015:Logistic Models; D009885:Ophthalmology / Q000379:methods / Q000592:standards*; D011379:Prognosis; D013030:Spain; D016896:Treatment Outcome; D014792:Visual Acuity