Predicting final visual acuity following cataract surgery

预测白内障手术后的最终视力

• 批准号: 9215348
• 负责人: LISA J HERRINTON
• 金额: $ 36.96万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-03-01 至 2019-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9215348
• 关键词: Address; Adoption; Adverse event; Affect; Anti-Inflammatory Agents; Anti-inflammatory; Benefits and Risks; Blindness; California; Cataract; Cataract Extraction; Climacteric; Clinical; Cohort Studies; Communities; Comorbidity; Complication; Computerized Medical Record; Country; Cystoid Macular Edema; Data; Decision Making; Diagnosis; Diagnostic; Drug usage; Effectiveness; Electronic Health Record; Ensure; Epidemic; Europe; Evaluation; Eye; Incidence; Knowledge; Literature; Longitudinal Studies; Measurement; Measures; Modeling; Modernization; Operative Surgical Procedures; Ophthalmologist; Optical Coherence Tomography; Outcome; Patients; Phacoemulsification; Pharmaceutical Preparations; Physicians; Population; Postoperative Complications; Postoperative Period; Practice Guidelines; Prevalence; Prevention; Recovery; Reporting; Research; Resolution; Risk; Role; Safety; Subgroup; Surgeon; Surgical complication; Techniques; Testing; Thick; Time; United States; Vision; Visual; Visual Acuity; Vulnerable Populations; base; clinical decision-making; clinical practice; clinical predictors; evidence base; experience; improved; individual patient; macular edema; outcome forecast; personalized care; population based; prevent; prognostic; prophylactic; prospective; relative effectiveness; research study; stem

ABSTRACT: Cataract surgery is the most commonly performed surgery in the United States. Despite this, we know surprisingly little about visual outcomes and rates of complications following contemporary cataract surgery, especially in population subgroups. This lack of knowledge is troubling given that emerging research from Europe suggests that cataract surgery might be ineffective for up to 6% of patients and present significant harms to another 2- 5%. Cystoid macular edema (CME), for example, is a common postoperative complication of cataract surgery. Since the adoption of optical coherence tomography, CME incidence has risen from ~2% to ~40%. However, cataract surgeons lack a clear understanding of what this diagnosis means. To address this issue, we propose a cohort study to generate real-world knowledge about cataract surgery prognosis, including visual outcomes and complication rates; CME diagnostic criteria that correlate with late postoperative vision loss; the prevention of significant CME; and differences in these topics among vulnerable population subgroups. The proposed study will include comprehensive, prospectively recorded data for approximately 186,000 patients and more than 250,000 eyes that received surgery at Kaiser Permanente Northern California from 2007 to 2016. The study will be the largest in the U.S.; will use detailed, comprehensive information that is prospectively recorded into the electronic medical record; and will use modern analytic techniques to ensure valid analyses. The well- characterized, community-based population is diverse, with 29% of patients being non-white and 43% having an ocular comorbidity. Together with the large number of cases, this high level of diversity will enable detailed sensitivity and subgroup analysis. Our results will allow cataract surgeons to individualize care for their patients. The results will also provide desperately needed evidence-based diagnostic criteria for CME. These criteria can be used in research studies, in clinical practice, and to develop practice guidelines. The exceptional volume of cataract surgery justifies research to improve decision-making of this life-changing surgery.

摘要：白内障手术是美国最常见的手术 States.尽管如此，我们对视力结果和患病率的了解却少得令人惊讶。 现代白内障手术后的并发症，特别是在人群亚组中。这 缺乏知识是令人不安的，因为来自欧洲的新研究表明，白内障 手术可能对高达6%的患者无效，并对另外2%的患者造成重大伤害 百分之五囊样黄斑水肿（CME），例如，是一种常见的术后并发症， 白内障手术自光学相干层析成像技术被采用以来，CME的发生率有所上升 从约2%到约40%。然而，白内障外科医生缺乏一个清晰的认识， 诊断手段。为了解决这个问题，我们提出了一个队列研究，以产生现实世界的 了解白内障手术预后，包括视力结果和并发症发生率; 与术后晚期视力丧失相关的CME诊断标准; 显著的继续医学教育;以及弱势群体在这些问题上的差异。的 拟议的研究将包括全面的，前瞻性记录的数据， 186，000名患者和超过250，000只眼睛在Kaiser Permanente接受手术 2007年至2016年的北方加州。这项研究将是美国规模最大的研究。将使用 详细、全面的信息，这些信息将被前瞻性地记录到电子医疗记录中。 记录;并将使用现代分析技术，以确保有效的分析。井- 以社区为基础的特征人群是多样化的，29%的患者是非白人 43%有眼部合并症。加上案件数量多， 多样性将使详细的敏感性和亚组分析。我们的研究结果将使白内障 外科医生为病人提供个性化护理。其结果也将提供绝望 需要循证医学诊断标准。这些标准可用于研究 研究，在临床实践中，并制定实践指南。的特殊体积 白内障手术证明了研究的合理性，以改善这种改变生活的手术的决策。