The Association Between Cataract Surgery and Progression of Diabetic Retinopathy

描述（由申请人提供）：在美国，糖尿病（DM）是导致失明的主要原因，影响着超过2100万人。糖尿病患者视力丧失最常见的原因是白内障和糖尿病视网膜病变（DR）。非糖尿病患者白内障手术的成功率通常很高。然而，在多个相对较小的观察性研究中，一部分糖尿病患者在白内障手术后出现DR进展，预后不佳。鉴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），并且随着美国人口老龄化，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。使用大型卫生保健数据库进行分析可以揭示各种医疗状况的护理模式和健康结果。本研究将对这些来源的纵向数据进行分析，以更好地了解白内障手术与dr的发展或进展之间可能存在的关联。与以往关于该主题的小型观察性研究不同，本项目将包括数千名接受白内障手术的糖尿病患者。此外，这种类型的研究成本大大低于进行随机对照试验。本研究使用两个数据来源：(1)医疗保险现行受益人调查（1992-2005），这是一项针对每年超过12,000名医疗保险受益人的全国代表性样本的医疗服务利用和成本的纵向数据调查，以及(2)i3 InVision（tm）数据集市（2004-2007），这是一个大型管理式医疗数据库，包含超过2400万名被覆盖生命的详细信息。使用这些来源的数据，对行白内障手术的糖尿病患者和年龄匹配的糖尿病对照和非糖尿病对照进行研究

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.