Quintana et al derived criteria for prioritizing cataract surgery using the RAND method. These can help determine who gets surgery first when there are limited medical resources. The authors are from the IRYSS Appropriateness Cataract Group and from Vizcaya, Spain.
Parameters:
(1) visual acuity in affected eye before surgery
(2) visual acuity expected after surgery
(3) current visual impairment (visual function)
(4) visual acuity in contralateral eye
(5) ocular comorbidities
(6) social dependence
(7) laterality
(8) appropriateness
Two methods were used to weight each parameter:
(1) optimal scaling
(2) general linear model
|
Parameter |
Findings |
Optimal |
Linear |
|
visual acuity before |
0.1 |
21 |
25 |
|
|
0.2 to 0.4 |
15 |
17 |
|
|
>= 0.5 |
0 |
0 |
|
visual acuity expected |
>= 0.5 |
21 |
29 |
|
|
0.2 to 0.4 |
13 |
18 |
|
|
0.1 |
0 |
0 |
|
visual function |
difficulty with ADL |
20 |
20 |
|
|
recreational difficulties |
10 |
11 |
|
|
glare |
4 |
5 |
|
|
unimpaired |
0 |
0 |
|
visual acuity other eye |
0.1 |
10 |
7 |
|
|
0.2 to 0.4 |
6 |
5 |
|
|
>= 0.5 |
0 |
0 |
|
ocular comorbidities |
simple cataract |
8 |
6 |
|
|
diabetic retinopathy |
4 |
3 |
|
|
other pathologies |
0 |
0 |
|
social dependence |
yes |
5 |
3 |
|
|
no |
0 |
0 |
|
laterality |
bilateral |
2 |
1 |
|
|
unilateral |
0 |
0 |
|
appropriateness |
yes |
13 |
9 |
|
|
no or uncertain |
0 |
0 |
where:
• ADL = activities of daily living
total score for optimal scaling =
= SUM(points for all 8 parameters)
total score for general linear model =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score by either method: 0
• maximum score by either method: 100
• The higher the score the greater the priority for having cataract surgery.
Specialty: Ophthalmology
