Visual functioning, patients should guide cataract surgery

About 1.3 million cataract extractions are performed on Medicare beneficiaries in the United States each year. Measures of patients' visual acuity often indicate only mild impairment when, in reality, cataracts are causing significant problems in daily life.

Thus physicians should rely more on patients' visual functioning and personal needs and preferences than on measures of visual acuity when assessing the need for cataract surgery, according to the Cataract Patient Outcomes Research Team (PORT), led by Earl P. Steinberg, MD, MPP, of The Johns Hopkins University School of Medicine in Baltimore and supported by the Agency for Health Care Policy and Research in Rockville, MD.

The researchers interviewed 47 patients over age 50 randomly selected from Baltimore ophthalmologists' offices who were scheduled to have routine cataract extraction within three months for an age-related cataract. The patients were asked to rate the effects of visual impairment on specific activities of their daily lives, including:

· work (job or home);

· leisure activities;

· walking;

· driving;

· interacting with people;

· concentrating and remembering things;

· feelings of frustration;

· feelings of depression.

Then they were asked to assign a preference value to their current vision on a scale ranging from 0 for complete blindness to 10 for perfect vision. Patients' preference values for their preoperative vision were more closely related to problems in specific aspects of daily life - especially feelings of depression and problems in social interaction - than to visual acuity in the operative eye, better eye, or worse eye, or a weighted average of visual acuity in both eyes. More than 60% of patients reported frustration with visual impairment, and more than 25% reported that their current vision caused problems with driving, leisure activities, walking, and working.

(Editor's note: For more details, see "Preference values for visual states in patients planning to undergo cataract surgery," by Eric B. Bass, MD, MPH, Stacey Wills, MPH, Ingrid U. Scott, MD, et al. in the July 1997 Medical Decision Making 17:324-330.)