Predicting final visual acuity following cataract surgery

摘要：白内障手术是美国最常见的手术。 各州。尽管如此，令人惊讶的是，我们对视觉效果和视障率知之甚少 当代白内障手术后的并发症，特别是在人口亚组中。这 缺乏知识令人担忧，因为来自欧洲的最新研究表明，白内障 手术可能对高达6%的患者无效，并对另2%的患者造成重大伤害- 5%。例如，囊样黄斑水肿(CME)是一种常见的术后并发症。 白内障手术。自从采用光学相干层析成像以来，CME的发生率有所上升 从~2%到~40%。然而，白内障外科医生对此缺乏明确的认识。 诊断意味着。为了解决这个问题，我们建议进行一项队列研究，以生成真实世界 关于白内障手术预后的知识，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；预防 显著的CME；以及弱势群体之间在这些主题上的差异。这个 拟议的研究将包括全面的、预期记录的数据，大约 在Kaiser Permanente接受手术的18.6万名患者和超过25万只眼睛 北加州从2007年到2016年。这项研究将是美国最大的；将使用 详细、全面的信息，前瞻性地记录到电子医疗中 记录；并将使用现代分析技术确保有效的分析。这口井- 以社区为基础的特色化人口是多样化的，29%的患者是非白人 43%的人患有眼部合并症。再加上大量的案件，这一高水平 多样性将使详细的敏感性和分组分析成为可能。我们的结果将允许白内障 外科医生为他们的病人提供个性化护理。结果也将不顾一切地提供 CME所需的循证诊断标准。这些标准可用于研究 研究，在临床实践中，并制定实践指南。超乎寻常的数量 白内障手术证明了研究的合理性，以改善这种改变人生的手术的决策。

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.