From the 2024 HVPA National Conference
Justin Flood BS (Loyola University Chicago Stritch School of Medicine), Roshni Koul BS, Max Whitmeyer MS, Jhansi Raju MD
Background
When assessing the value of healthcare, the standard has typically been to rely on a set of quality metrics defined by laboratory values, clinical tests, and complication rates. However, these are rarely the same metrics that patients use to quantify success. What holds importance to the patient transcends numbers gleaned from a controlled environment. Instead, patients are concerned with their ability to maintain independence, actively engage in daily activities, fulfill familial responsibilities, and pursue their career goals, hobbies, and interests.
To properly ascertain success from the patient’s perspective, patient-reported outcome measure (PROM) studies have become increasingly relevant. For cataract surgery in particular, several survey methods have been proven to reliably measure quality of life and engagement in activities of daily living following surgery. The Catquest-9SF questionnaire used in our study is a validated survey that poses nine questions to ascertain details about activities of daily living (ADA).
Objective
Our objective was to demonstrate the difference between pre- and post-surgery survey results, as well as to analyze any correlation between the survey results and Snellen visual acuity improvements in a VA population. We also analyzed how the survey results vary with confounding diseases, such as macular degeneration, diabetic retinopathy, and glaucoma, and status of first-eye cataract surgery vs. second-eye cataract surgery.
Methods
We included all patients scheduled for cataract surgery without additional simultaneous surgery and excluded patients scheduled for corrective cataract surgery following complications. Patients were called one week prior to surgery and again three months post-surgery. We used independent-samples Mann-Whitney U test and Fischer’s exact test for statistical analysis.
Results
Twenty-nine participants responded to the survey. Sixteen participants were scheduled for their first cataract surgery (55.2%) and thirteen participants were scheduled for their second cataract surgery (44.8%). The average baseline LogMAR visual acuity was 0.38 ± 0.4. There were no significant differences in first-eye vs. fellow-eye results both in the presence and absence of ocular comorbidity (p>0.05). There was a significant increase in both survey results and LogMAR visual acuity from pre-surgery to post-surgery (p<0.01).
Conclusions
This is an ongoing study with a current total sample size of 143 completed surveys. Our preliminary data displays the positive benefits of cataract surgery performed at the Hines VA from both the patient perspective and changes in their visual acuity. This benefit is not significantly impacted by the presence of a comorbidity or status of their first vs. second cataract surgery. Further analysis will reveal the impact of the type of IOL on survey results.
General Implications
These findings provide data to educate veterans on the potential success of their cataract surgery as it relates to values that are meaningful to them. It will also allow surgeons to have more robust discussions with patients about expectations and benefits of surgery given their comorbidities and surgery status.