title: Validation of priority criteria for cataract extraction.
abstract: OBJECTIVE
  Given the increasing prevalence of cataract and demand for cataract extraction surgery, patients must often wait to undergo this procedure. We validated a previously developed priority scoring system in terms of clinical variables, pre-intervention health status, appropriateness of surgery and gain in visual acuity (VA) and health-related quality of life (HRQoL).
  
  
  METHODS
  Explicit prioritization criteria for cataract extraction created by a variation of the Research and Development (RAND) and University of California Los Angeles appropriateness methodology were retrospectively applied to a prospective cohort of 5257 patients on waiting lists to undergo cataract by phacoemulsification at 17 hospitals in Spain. Demographic data, clinical data and data related to surgical technique were collected by trained ophthalmologists. Patients were evaluated by their ophthalmologist before the intervention and 6 weeks afterward. They also completed, by mail, the Visual Function Index (VF-14) before the intervention and 3 months afterward.
  
  
  RESULTS
  High-priority patients experienced greater improvement in VA and HRQoL than those classified as intermediate or low-priority (P < 0.0001), even after adjusting by VA and the VF-14 score at baseline. The time to intervention was the same for high-priority patients as it was for intermediate and low-priority patients.
  
  
  CONCLUSIONS
  The priority score we developed identified patients most likely to experience the greatest improvements from cataract extraction. Use of this tool could provide a fairer and more rational way to prioritize patients for cataract extraction.
authors.affiliation: Research Unit, Unidad de Investigación, Hospital Galdakao-Usansolo-CIBER Epidemiología y Salud Pública (CIBERESP), Galdakao, Bizkaia, Spain. susana.garciagutierrez@osakidetza.net
authors.forename: Susana García
authors.initials: SG
authors.lastname: Gutiérrez
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Quintana
authors.forename: Amaia
authors.initials: A
authors.lastname: Bilbao
authors.forename: Antonio
authors.initials: A
authors.lastname: Escobar
authors.forename: Emilio Perea
authors.initials: EP
authors.lastname: Milla
authors.forename: Belen
authors.initials: B
authors.lastname: Elizalde
authors.forename: Marisa
authors.initials: M
authors.lastname: Baré
authors.forename: Nerea
authors.initials: N
authors.lastname: Fernandez de Larrea
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction; D004608:Eligibility Determination; D005260:Female; D006292:Health Priorities; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D013030:Spain; D011795:Surveys and Questionnaires; D055815:Young Adult