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 国家。尽管如此，我们对视觉结果和发生率却知之甚少。 现代白内障手术后的并发症，特别是在人群亚组中。这 鉴于欧洲的新兴研究表明白内障，缺乏知识是令人不安的 手术可能对多达 6% 的患者无效，并对另外 2% 的患者造成重大伤害 5%。例如，黄斑囊样水肿（CME）是一种常见的术后并发症。 白内障手术。自采用光学相干断层扫描以来，CME 发生率有所上升 从~2% 到~40%。然而，白内障外科医生对此缺乏清晰的了解 诊断手段。为了解决这个问题，我们提出了一项队列研究来生成真实世界 有关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 重要的 CME；以及弱势群体在这些主题上的差异。这 拟议的研究将包括全面的、前瞻性的记录数据，大约为 186,000 名患者和超过 250,000 只眼睛在 Kaiser Permanente 接受了手术 2007 年至 2016 年在北加州进行。该研究将是美国最大的研究；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来确保分析有效。井- 以社区为基础的人群具有多样性，其中 29% 的患者是非白人 43% 患有眼部合并症。再加上大量的病例，这种高水平 多样性将使详细的敏感性和亚组分析成为可能。我们的结果将允许白内障 外科医生为患者提供个性化护理。结果也将提供绝望 CME 需要循证诊断标准。这些标准可用于研究 研究，临床实践，并制定实践指南。非凡的体积 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。