The Cataract National Dataset electronic multi-centre audit of 55 567 operations: risk indicators for monocular visual acuity outcomes

Abstract

Aims To report risk factors for visual acuity (VA) improvement and harm following cataract surgery using electronically collected multi-centre data conforming to the Cataract National Dataset (CND). Methods Routinely collected anonymised data were remotely extracted from the electronic patient record systems of 12 participating NHS Trusts undertaking cataract surgery. Following data checks and cleaning, analyses were performed to identify risk indicators for: (1) a good acuity outcome (VA 6/12 or better), (2) the pre-to postoperative change in VA, and (3) VA loss (doubling or worse of the visual angle). Results In all, 406 surgeons from 12 NHS Trusts submitted data on 55 567 cataract operations. Preoperative VA was known for 55 528 (99.9%) and postoperative VA outcome for 40 758 (73.3%) operations. Important adverse preoperative risk indicators found in at least 2 of the 3 analyses included older age (3), short axial length (3), any ocular comorbidity (3), age-related macular degeneration (2), diabetic retinopathy (3), amblyopia (2), corneal pathology (2), previous vitrectomy (2), and posterior capsule rupture (PCR) during surgery (3). PCR was the only potentially modifiable adverse risk indicator and was powerfully associated with VA loss (OR ¼ 5.74). Conclusion Routinely collected electronic data conforming to the CND provide sufficient detail for identification and quantification of preoperative risk indicators for VA outcomes of cataract surgery. The majority of risk indicators are intrinsic to the patient or their eye, with a notable exception being PCR during surgery.

Are rates of vision loss in patients in English glaucoma clinics slowing down over time? Trends from a decade of data

“…These assessments can be carried out by taking advantage of large data sets collected from electronic patient records, and there are some good recent examples of this type of approach being used in ophthalmology. [5][6][7][8] Automated perimetry has been routinely used in glaucoma clinics for more than 20 years and VF data recorded electronically in many centres can be used to monitor trends in health service delivery of glaucoma. 9,10 This approach, using large-scale VF data, is adopted in the methodology of this study.…”

Previous Intravitreal Therapy Is Associated with Increased Risk of Posterior Capsule Rupture during Cataract Surgery

“…11 Analyses of large cataract surgery datasets have identified many risk factors for PCR during cataract surgery; however, none have investigated previous intravitreal therapy as a possible risk indicator. 9,12 The aim of this analysis is test the hypothesis that previous intravitreal therapy is associated with a higher risk of PCR during cataract surgery.…”

The Royal College of Ophthalmologists’ National Ophthalmology Database Study of cataract surgery: report 2, relationships of axial length with ocular copathology, preoperative visual acuity, and posterior capsule rupture

“…The RCOphth NOD is the formalised successor to the ad hoc collaboration that resulted in the Cataract National Dataset publications. [1][2][3][4][5] The RCOphth NOD covers a range of conditions and operations. [6][7][8][9] RCOphth NOD data on cataract surgery complication rates, visual outcomes, and proportions with ocular copathology have already been reported.…”