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Patient factors rather than differences in medical management affect visual acuity after cataract surgery

Denmark, Spain, Canada, and the United States manage cataract surgery and care differently. For instance, in Denmark, cataract extractions are mainly performed in public hospitals, while in North America and Spain, extractions are performed both in hospitals and in private clinics. Ophthalmologic and medical preoperative testing, as well as intraoperative monitoring, is much more intensive in North America and Spain than in Denmark. Physicians in Spain make significantly greater use of general anesthesia, but very infrequently perform phacoemulsification compared with physicians at the other three sites.

Despite variations in surgical techniques and management of cataracts, similar patients in the four countries had similar visual acuity following cataract surgery, according to this study, which was supported in part by the Agency for Health Care Policy and Research (HS07085). These were patients with comparable preoperative characteristics and no other coexisting medical problems. Patient age, preoperative visual acuity, general health status, and coexisting ocular abnormalities, rather than cataract management, predicted visual outcomes, explains Gerard F. Anderson, Ph.D., of Johns Hopkins University.

Dr. Anderson and his colleagues examined preoperative and 4-month postoperative interview data and visual acuity on patients 50 years of age and older scheduled for first-eye cataract surgery at multiple centers in four countries (772 in the United States, 159 in Canada, 291 in Denmark, and 200 in Spain). After accounting for differences in patient characteristics, there was no significant difference across the four sites in mean 4-month postoperative visual acuity.

For more details, see "Visual outcomes of cataract surgery in the United States, Canada, Denmark, and Spain: Report from the International Cataract Surgery Outcomes Study," by Jens Christian Norregaard, M.D., Ph.D., Charlotte Hindsberger, M.Sc., Jordi Alonso, M.D., Ph.D., and others, in the Archives of Ophthalmology 116, pp. 1095-1100, 1998.

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