Rigor of Research Methods in Studies of the Effectiveness and Safety of Cataract Extraction With Intraocular Lens Implantation

Nr, Powe; Tielsch, James M.; Schein, OD; Luthra, Rajiv; Ep, Steinberg

doi:10.1001/archopht.1994.01090140104032

Cited by 19 publications

(3 citation statements)

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“…1,4 Cataract surgery can lead to posterior capsule opacification of the implanted lens, requiring further procedures; reported rates of this complication vary widely from 0.7% to 48%. 17,25 A systematic review from 1998 reported an incidence of 28% at 5 years. 26 Endophthalmitis, bullous keratopathy, dislocation of intraocular lens, macular edema, and retinal detachment are other complications associated with cataract surgery.…”

Section: Potential Harms Of Screening and Treatmentmentioning

confidence: 99%

Screening for Impaired Visual Acuity in Older Adults

Siu¹,

Bibbins‐Domingo

Grossman

et al. 2016

JAMA

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T he US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms. It bases its recommendations on the evidence of both the benefits andharmsoftheserviceandanassessmentofthebalance.TheUSPSTF does not consider the costs of providing a service in this assessment. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Summary of Recommendation and Evidence The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in older adults. (I statement) (Figure 1) See the Clinical Considerations section later in this article for suggestions for practice regarding the I statement. Rationale Importance Impairment of visual acuity is a serious public health problem in older adults. In 2011, about 12% of US adults aged 65 to 74 years and 15% of those 75 years or older reported having problems seeing, even with glasses or contact lenses. Detection The USPSTF found convincing evidence that screening with a visual acuity test can identify persons with a refractive error. The USPSTF found convincing evidence that screening questions are not as accurate as visual acuity testing for assessing visual acuity. The USPSTF found adequate evidence that visual acuity testing alone does not accurately identify early age-related macular degeneration (AMD) or cataracts. Benefits of Detection and Early Treatment The USPSTF found inadequate overall evidence on the benefits of screening, early detection, and treatment to provide a coherent assessment of the overall benefits. Several studies evaluated the direct benefit of screening and reported no reductions in vision disorders or vision-related function in screened populations; however, these studies had limitations, including differing control interventions, high loss to follow-up, and low uptake of treatment. The USPSTF found adequate evidence that early treatment of refractive error, cataracts, and AMD improves or prevents loss of visual acuity. Harms of Detection and Early Treatment The USPSTF found inadequate evidence on the harms of screening. The USPSTF found adequate evidence that early treatment of refractive error, cataracts, and AMD may lead to harms that are small to none. DESCRIPTION Update of the US Preventive Services Task Force (USPSTF) recommendation on screening for impaired visual acuity in older adults. METHODS The USPSTF reviewed the evidence on screening for visual acuity impairment associated with uncorrected refractive error, cataracts, and age-related macular degeneration among adults 65 years or older in the primary care setting; the benefits and harms of screening; the ac...

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Section: Potential Harms Of Screening and Treatmentmentioning

confidence: 99%

Screening for Impaired Visual Acuity in Older Adults

Siu¹,

Bibbins‐Domingo

Grossman

et al. 2016

JAMA

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“…However, some panels have found few intervention trials whose ndings could inform the development of prac-tice guidelines. For example, the PORT focusing on cataract surgery uncovered only seven comparative studies of extraction procedures that had been conducted between 1979 and 1991 (Powe et al, 1994). In contrast, Miller and his colleagues (1995) reviewed 219 comparative trials of treatments for alcohol use disorders, many of which employed random assignment of patients to treatment conditions.…”

Section: Introductionmentioning

confidence: 99%

Limitations in using existing alcohol treatment trials to develop practice guidelines

Finney

2000

Addiction

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In recent years, substantial efforts have been made to identify "best practices" and develop comprehensive practice guidelines for the treatment of various psychiatric disorders and medical conditions, based on systematic, often quantitative reviews of the existing intervention research. There probably are more than 300 comparative treatment trials that have been conducted in the alcohol field. With this large body of research, one might think the development of alcohol treatment guidelines would be a straightforward task. Unfortunately, that is not the case. Four problems are discussed with the "box-score" reviews that have been conducted thus far to identify effective alcohol treatment modalities. At least two of these problems are fundamental barriers to determining the relative efficacy or effectiveness of alcohol treatment modalities even in "meta-analyses" with "effect sizes". These impediments are discussed, as is how future alcohol treatment trials could be conducted so that their findings would more readily inform practice guidelines.

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“…The term effectiveness, however, is used for different purposes in literature (Muir Gray 1997). The most common meaning nowadays seems to be how well a therapy or intervention works (Espallargues et al 1998; Laidlaw et al 1998; Powe et al 1994). An important issue related to effectiveness is to calculate economic efficiency.…”

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confidence: 99%

Cataract surgery and effectiveness 2. An index approach for the measurement of output and efficiency of cataract surgery at different surgery departments

Lundström

Roos

Brege

et al. 2001

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: To describe a model for comparing the performance of cataract surgery among ophthalmology departments in terms of economic efficiency. Methods: An index approach for the measurement of outcome of cataract surgery is modeled. The index approach uses information about activities and difficulties in daily life as well as visual acuity and age. The change in activities and difficulties after surgery is expressed by changes in distances, and an overall index score is calculated as ratios of values to distances. Values to distances are estimated as solutions to linear programming problems. Index scores are calculated for two groups of patients, those with an ocular co-morbidity and those without. Economic efficiency is also estimated by use of an index approach. In the estimation of efficiency we use the calculated index scores of outcome of surgery as a measure of output of the ophthalmology department. Four different departments providing cataract surgery are compared. Results: The studied departments showed differences to a great extent when traditional measures of cataract surgery outcomes were used. These differences changed when the outcomes were compared by use of index scores. When economic efficiency was calculated the difference between the departments was further reduced and only one department was considered inefficient according to the model. Conclusion: An index approach was used to study outcomes of cataract surgery and economic efficiency in four departments. This approach takes into account the complexity of cost in relation to feasible outcome. The ranking between the departments described by traditional methods turned out differently using the model.

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Rigor of Research Methods in Studies of the Effectiveness and Safety of Cataract Extraction With Intraocular Lens Implantation

Cited by 19 publications

References 0 publications

Screening for Impaired Visual Acuity in Older Adults

Screening for Impaired Visual Acuity in Older Adults

Limitations in using existing alcohol treatment trials to develop practice guidelines

Cataract surgery and effectiveness 2. An index approach for the measurement of output and efficiency of cataract surgery at different surgery departments

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