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）是失明的主要原因，影响超过2100万人。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）。非糖尿病患者白内障手术的成功率通常很高。然而，在多项相对较小的观察性研究中，一部分糖尿病患者在白内障手术后发生DR进展，结局不太理想。鉴于监测和治疗白内障和DR的资源成本很高（1996-2000年超过50亿美元），并且随着美国人口老龄化，这些疾病的诊断将增加，从患者护理和健康政策的角度来看，识别白内障手术后DR进展的可能风险因素非常重要。使用大型医疗保健数据库的分析可以揭示各种医疗条件的护理模式和健康结果。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发展或进展的可能关联。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，这种类型的研究成本大大低于进行随机对照试验。本研究使用两个数据源：（1）Medicare当前受益人调查（1992-2005年），一项关于医疗服务利用和费用的纵向数据的调查，每年对12，000多名医疗保险受益人进行全国代表性抽样，以及（2）i3 InVision（tm）数据集市（2004-2007年），这是一个大型的管理式医疗数据库，其中有2400多万人的详细信息。使用这些来源的数据，对接受白内障手术的糖尿病患者和年龄匹配的糖尿病对照组， 白内障手术，我们将评估白内障手术是否与糖尿病患者DR发病或进展的风险增加、使用更多资源监测和治疗DR或护理费用增加相关。最后，在条件logistic回归中，我们将检查人口统计学或临床因素（例如，血糖控制不良）与白内障手术后DR或DR进展风险升高相关。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”患者亚组，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.