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  • Variation in indications for cataract surgery in the United States, Denmark, Canada, and Spain: results from the International Cataract Surgery Outcomes Study

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Original Article
Variation in indications for cataract surgery in the United States, Denmark, Canada, and Spain: results from the International Cataract Surgery Outcomes Study
  1. Jens Christian Norregaarda,b,
  2. Peter Bernth-Petersenb,
  3. Jordi Alonsoc,
  4. Elaine Dunnd,e,
  5. Charlyn Blackd,f,
  6. Tavs Folmer Andersena,
  7. Mireia Espallarguesc,
  8. Lorne Bellang,
  9. Gerard F Andersonh
  1. aInstitute of Public Health, Faculty of Health Sciences, University of Copenhagen, Denmark, bDepartment of Ophthalmology, Hvidovre University Hospital, Copenhagen, Denmark, cHealth Services Research Unit, Institut Municipal d’Investigació Mèdica, Barcelona, Spain, dDepartment of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Canada, eHealth Sciences Clinical Research Centre, Winnipeg, Canada, fManitoba Centre for Health Policy and Evaluation, University of Manitoba, Winnipeg, Canada, gDepartment of Ophthalmology, Faculty of Medicine, University of Manitoba, Winnipeg, Canada, hDepartment of Health Policy and Management, Johns Hopkins University, Baltimore, USA
  1. Dr Jens Christian Norregaard, Institute of Public Health, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark.

Abstract

BACKGROUND/AIMS International comparisons of clinical practice may help in assessing the magnitude and possible causes of variation in cross national healthcare utilisation. With this aim, the indications for cataract surgery in the United States, Denmark, the province of Manitoba (Canada), and the city of Barcelona (Spain) were compared.

METHODS In a prospective multicentre study, patients scheduled for first eye cataract surgery and aged 50 years or older were enrolled consecutively. From the United States 766 patients were enrolled; from Denmark 291; from Manitoba 152; and from Barcelona 200. Indication for surgery was measured as preoperative visual status of patients enlisted for cataract surgery. Main variables were preoperative visual acuity in operative eye, the VF-14 score (an index of functional impairment in patients with cataract) and ocular comorbidity.

RESULTS Mean visual acuity were 0.23 (USA), 0.17 (Denmark), 0.15 (Manitoba), and 0.07 (Barcelona) (p<0.001). When restricting the sample to eyes with normal retina and macula, no significant difference between United States and Denmark was observed (p>0.05). Mean VF-14 scores were 76 (USA), 76 (Denmark), 71 (Manitoba), and 64 (Barcelona) (p<0.001).

CONCLUSION Similar indications for cataract surgery were found in the United States and Denmark. Significantly more restricted indications were observed in Manitoba and Barcelona. Possible explanations for the results are discussed, including differences in sociodemographic characteristics, access to care, surgeons’ willingness to operate, and patient demand.

  • cataract surgery
  • North America
  • Europe

https://doi.org/10.1136/bjo.82.10.1107

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