Authors: Evan Michaelov, Matthew Schlenker, Morgan Lim, Chelsea D'Silva, Simona Minotti, Dean Smith, Devesh Varma, Robert Reid, Iqbal Ike K. Ahmed

Author Disclosure Block: E. Michaelov: None. M. Schlenker: Allergan, Aequus, Alcon, J&J, Light Matter Interaction, Santen, Thea-Labtician – Consulting Fees and/or Honoraria. M. Lim: None. C. D'Silva: None. S. Minotti: None. D. Smith: None. D. Varma: Abbot, Labtician, Alcon, Allergan, Alcon, Allergan, Bausch + Lomb, Pfizer – Consultant and/or Speaker. R. Reid: None. I.I.K. Ahmed: Consultant, Honoraria and/or Research Grant & Support; Acucela, Aerie Pharmaceuticals, Alcon, Allergan, ArcScan, Bausch and Lomb, Beaver Visitec, Camras Vision, Carl Zeiss Meditec, Centervue, Ellex, ElutiMed, Equinox, ForSight Labs, Genentech, Glaukos, Gore, Iantech, InjectSense, Iridex, iStar, Ivantis, KeLoTec, LayerBio, Leica Microsystems, MicroOptx, New World Medical, Omega Ophthalmics, PolyActiva, Sanoculis, Santen, Science Based Health, Sight Sciences, Stroma, TrueVision, Vizzario, Johnson & Johnson Vision.

Abstract Body:

Purpose: To determine the influence of patient-evaluation metrics, and physician appropriateness and prioritization on scheduled cataract surgery.

Study Design: Prospective interventional cohort study.

Methods: 158 patients (Cohort A) and 312 patients (Cohort B) enrolled from September 2016 to May 2017 in Mississauga, ON received cataract clinical assessment (4 surgeons for Cohort A; 7 for Cohort B). Physicians evaluated patients for cataract surgery appropriateness and prioritization (both scale 1-10); and patients completed eCAPS (Cohorts A and B), CatQuest, and EQ5D questionnaires (Cohort B). The association between appropriateness and prioritization, and patient-reported function were explored using Kruskal-Wallis testing, logistic regression, and Spearman’s correlation coefficients, as appropriate.

Results: 89.3% of patients referred for cataract surgery were deemed appropriate as defined by a score of ≥6 (median 8; IQR 7-9 in both cohorts). Median appropriateness ratings were dissimilar amongst physicians (Kruskal-Wallis, p<0.001). The greatest associations with being deemed appropriate for cataract surgery were ipsilateral visual acuity (VA) of 20/50 or worse (OR=3.10, p<0.01) and impairment in night driving (OR=2.87, p<0.01). Additionally, 8 (33%) of the patient reported quality of life questions were associated with patients being deemed appropriate for cataract surgery. In contrast, prioritization ratings followed a normal distribution with a median of 5 (IQR 4-7) in Cohort A and 6 (IQR 5-7) in Cohort B (Kruskal-Wallis p<0.001). Significant associations with an increase in prioritization scores included ipsilateral VA worse than 20/50, contralateral VA worse than 20/50, and increasing scores in 13 (54%) of the patient reported quality of life questions. The physician conducting the visit and the patient's income also had a statistically significant impact on the priority rating. Ordinal regression identified only ipsilateral VA 20/50 or worse (p<0.01), eCAPS Q5 (p<0.01) and income of 30 000-49 999 (p<0.01) and 50 000 - 69 999 (p<0.01) as significant predictors of increased prioritization ratings. Spearman’s correlation revealed preop eCAPS aggregate (rho=0.141, p=0.002) and CatQuest aggregate (rho=0.120, p=0.034) as having a significant correlation with prioritization scores. EQ5D aggregate scores did not demonstrate any significant correlation with physician prioritization.

Conclusions: There is significant discordance between physician reported outcomes and patient reported functional status. The most significant association with appropriateness and prioritization was ipsilateral VA of 20/50 or worse. This analysis highlights that patients and physicians may have different views of appropriateness and prioritization. Future studies will explore the factors involved in improving patient-reported functional status following cataract surgery.