NIKE: a new clinical tool for establishing levels of indications for cataract surgery.
OBJECTIVE
The purpose of this study was to construct a new clinical tool for establishing levels of indications for cataract surgery, and to validate this tool.


METHODS
Teams from nine eye clinics reached an agreement about the need to develop a clinical tool for setting levels of indications for cataract surgery and about the items that should be included in the tool. The tool was to be called 'NIKE' (Nationell Indikationsmodell för Kataraktextraktion). The Canadian Cataract Priority Criteria Tool served as a model for the NIKE tool, which was modified for Swedish conditions. Items included in the tool were visual acuity of both eyes, patients' perceived difficulties in day-to-day life, cataract symptoms, the ability to live independently, and medical/ophthalmic reasons for surgery. The tool was validated and tested in 343 cataract surgery patients. Validity, stability and reliability were tested and the outcome of surgery was studied in relation to the indication setting.


RESULTS
Four indication groups (IGs) were suggested. The group with the greatest indications for surgery was named group 1 and that with the lowest, group 4. Validity was proved to be good. Surgery had the greatest impact on the group with the highest indications for surgery. Test-retest reliability test and interexaminer tests of indication settings showed statistically significant intraclass correlations (intraclass correlation coefficients [ICCs] 0.526 and 0.923, respectively).


CONCLUSIONS
A new clinical tool for indication setting in cataract surgery is presented. This tool, the NIKE, takes into account both visual acuity and the patient's perceived problems in day-to-day life because of cataract. The tool seems to be stable and reliable and neutral towards different examiners.
Lundström
Mats
M
EyeNet Sweden, Blekinge Hospital, Karlskrona, Sweden. mats.lundstrom@ltblekinge.se
Albrecht
Susanne
S
Håkansson
Ingemar
I
Lorefors
Ragnhild
R
Ohlsson
Sven
S
Polland
Werner
W
Schmid
Andrea
A
Svensson
Göran
G
Wendel
Eva
E
D000203:Activities of Daily Living; D000368:Aged; D002386:Cataract / Q000145:classification*; D002387:Cataract Extraction / Q000592:standards*; D005260:Female; D006292:Health Priorities / Q000592:standards; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000458:organization & administration*; D015588:Observer Variation; D009885:Ophthalmology / Q000592:standards*; D018579:Patient Selection; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D014792:Visual Acuity / Q000502:physiology*; D014850:Waiting Lists