Initial two years of experience with the AAO National Eyecare Outcomes Network (NEON) cataract surgery database

Abstract

Purpose To report the results of the first 2 years of experience with an American Academy of Ophthalmology (AAO) cataract surgery registry; to compare patient characteristics, operative procedures, and patient outcomes observed in the registry to those observed in the Cataract PORT study; and to discuss the current shortcomings and potential benefits of a national cataract surgery registry. Design Observational study of episodes of cataract surgery reported by a self-selected sample of 249 ophthalmologists. Participants Seven thousand six hundred twenty-six patients undergoing cataract surgery during 1996 and 1997. Methods Beginning in January 1996, participation in the AAO cataract surgery registry was offered to all ophthalmologists. Participants could use software or paper data collection forms to submit a common set of data regarding patients’ demographics, preoperative ophthalmologic history, physical examination and test results, functional status and symptoms, intraoperative procedures and events, and postoperative outcomes for all patients undergoing first or second eye cataract surgery. Data were transmitted to a central database, where they were aggregated and analyzed. Findings were compared with those observed in the Cataract PORT study, which was conducted in 1991 and 1992. Results Between January 1, 1996, and February 28, 1998, 249 ophthalmologists submitted data on at least one patient who underwent cataract surgery. A total of 7626 patients undergoing first or second eye surgery were enrolled, with all preoperative, intraoperative, and postoperative data forms submitted for 3342 patients (44%). The preoperative characteristics of patients reported to National Eyecare Outcomes Network (NEON) were similar to those of patients enrolled in the Cataract PORT study except for a higher reported prevalence of ocular comorbidity in NEON patients. Use of retrobulbar anesthesia was reported far less commonly, and use of topical anesthesia, phacoemulsification, and foldable intraocular lenses was reported far more often for NEON than for Cataract PORT study patients. Patient outcomes reported to NEON were similar to those observed in the Cataract PORT study. Main outcome measures Visual acuity, VF-14, Cataract Symptom Score, surgical complications. Conclusions During the first 2 years of NEON, ophthalmologist participation in the NEON cataract surgery database was low and consisted of a self-selected and likely nonrepresentative sample of ophthalmologists. The representativeness of patients for whom data were reported is unknown. In addition, complete data were submitted on only a minority of patients who were enrolled. Even so, the preoperative characteristics of patients on whom data were submitted to NEON were similar to those of patients enrolled in the Cataract PORT study. The initial experience with NEON demonstrates that it is technically possible to collect clinical data from, and report aggregated results to, practicing clinicians’ offices. In addition, at least some practicing clinicians are willing to spend the time required to participate in the NEON registry. The NEON cataract surgery database thus has the potential to provide a practical means for tracking practice patterns and patient outcomes in real time. If a representative sample of physicians was willing to contribute data systematically and accurately over time, initiatives such as NEON could provide a means for professional societies and physicians to play a leadership role in defining and monitoring quality of care.