The Association Between Cataract Surgery and Progression of Diabetic Retinopathy

描述(申请人提供)：在美国，糖尿病(DM)是导致失明的主要原因，影响着2100多万人。糖尿病患者视力丧失的最常见原因是白内障和糖尿病视网膜病变(DR)。非糖尿病患者的白内障手术成功率一般很高。然而，在多项相对较小的观察性研究中，一部分糖尿病患者经历了白内障手术后DR的进展和不太有利的结果。由于监测和治疗白内障和DR的资源成本很高(1996-2000年为50亿美元)，而且随着美国人口老龄化，对这些疾病的诊断将会增加，从患者护理和卫生政策的角度来看，确定白内障手术后DR进展的可能危险因素是很重要的。使用大型医疗保健数据库的分析可以揭示各种医疗条件下的护理模式和健康结果。这项拟议的研究将分析来自这些来源的纵向数据，以更好地了解白内障手术与DR发展或进展的可能联系。与以前关于这一主题的小型观察性研究不同，该项目将包括数千名接受白内障手术的DM患者。此外，这种类型的研究比进行随机对照试验的成本要低得多。这项研究使用了两个数据来源：(1)联邦医疗保险当前受益人调查(1992-2005年)，这是一项关于医疗服务利用和费用的纵向数据调查，每年有超过12000名联邦医疗保险受益人的全国代表性样本，以及(2)i3 Invision(Tm)数据集市(2004-2007年)，这是一个大型管理保健数据库，包含2400多万人受保生活的详细信息。使用来自这些来源的数据对接受白内障手术的糖尿病患者和年龄匹配的糖尿病和非糖尿病患者进行研究 对于白内障手术，我们将评估白内障手术是否与DR发病或进展的风险增加、使用更多的资源来监测和治疗DR或DM患者的护理成本增加有关。最后，在条件Logistic回归中，我们将检验人口统计或临床因素(例如，血糖控制不佳)是否与白内障手术后DR或DR进展的风险增加相关。通过阐明白内障手术后DR发病和进展的危险因素，我们可以更密切地监测这一“高危”患者，并研究早期干预措施以减少DR进展和视力丧失。

DESCRIPTION (provided by applicant): In the United States, diabetes mellitus (DM), a major cause of blindness, affects more than 21 million persons. The most common reasons for vision loss in those with DM are cataract and diabetic retinopathy (DR). Success rates of cataract surgery in persons without DM are generally very high. However, in multiple relatively small observational studies, a subset of patients with DM experience progression of DR after cataract surgery and less-favorable outcomes. Given the high costs of resources to monitor and treat cataract and DR (>$5 billion in 1996-2000) and that diagnoses of these conditions will increase as the U.S. population ages, it is important from both patient-care and health-policy perspectives to identify possible risk factors for DR progression after cataract surgery. Analyses using large health care databases can reveal patterns of care and health outcomes for various medical conditions. The proposed study would analyze longitudinal data from such sources to better understand the possible association of cataract surgery with development or progression of DR. Unlike the previous small observational studies on this topic, this project would include thousands of patients with DM undergoing cataract surgery. Furthermore, this type of study costs considerably less than conducting a randomized, controlled trial. This study uses two data sources: (1) the Medicare Current Beneficiaries Survey (1992-2005), a survey with longitudinal data on medical services utilization and costs for a nationally representative sample of more than 12,000 Medicare beneficiaries annually, and (2) the i3 InVision(tm) Data Mart (2004-2007), a large managed-care database with detailed information on more than 24 million covered lives. Using data from these sources on patients with DM who have cataract surgery and age-matched controls with DM and no cataract surgery, we will assess whether cataract surgery is associated with an increased risk for DR onset or progression, use of more resources to monitor and treat DR, or higher costs of care in patients with DM. Last, in a conditional logistic regression, we will examine whether demographic or clinical factors (e.g., poorly controlled blood sugar) are associated with elevated risk for DR or DR progression after cataract surgery. By elucidating risk factors for DR onset and progression after cataract surgery, we could more closely monitor this "high-risk" subset of patients and study early interventions to reduce DR progression and vision loss.