Cataract surgery is the most common operation on the NHS, yet surgeons currently assess vision using single-eye letter charts that bear little resemblance to how people actually see with both eyes open. This research programme will develop a patient-reported outcome measure (Cat-PROM) that captures how cataracts affect a person’s real-world visual disability, and then use it to predict who will benefit most from surgery. The team will also validate risk models for complications and vision loss using data from roughly 250,000 procedures across 30 NHS trusts, and build a decision-support calculator that gives patients personalised predictions of both benefit and harm. If successful, the work would replace a one-size-fits-all consent process with tailored information: a patient could know their individual odds of improved vision versus surgical complications before deciding. For the NHS, the risk models would help allocate high-risk cases to the most experienced surgeons and enable fairer comparisons of surgical outcomes across different case mixes.
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Cataract is an extremely common potentially blinding age related condition with cataract surgery the most frequently undertaken surgical procedure on the NHS. Currently pre- and postoperative vision assessments are based on monocular (one eye at a time) letter recognition tasks of limited relevance to a person s everyday vision with both eyes open. UK relevant patient reported measures of visual disability from cataract and its relief from surgery are lacking. This research programme will address a series of issues of direct relevance to the perceptions of people with cataract undergoing surgery in 4 work packages (WP). WP1: Measuring Visual Disability Development of a cataract patient-reported outcome measure (Cat-PROM) A self-reported visual disability measurement instrument for cataract and its relief through surgery will be developed based on our published and pilot work. Iterative development in typical cataract patients will take place in 4 NHS service settings in England. Robust methodology, including Rasch analysis, will deliver an interval scaled instrument with the ordinal response options (and respondents) positioned along the same underlying continuous latent scale of cataract visual disability measured in units of Logits. Cat-PROM will be relevant to the UK population and suitable for routine NHS use. Benefits Patients: A measure of cataract visual disability of direct relevance to patients self-reported experience of their vision before and after cataract surgery. NHS: A patient reported outcome measure for cataract. WP2: Predicting Harm Validation of risk models for complications and vision loss from surgery In parallel, we will obtain from the National Ophthalmology Database (NOD) project electronically extracted detailed data on ~250,000 cataract procedures from 30 NHS trusts. We will validate or update (if needed) our existing risk model for prediction of surgical complications (intraoperative posterior capsular rupture, PCR) and postoperative monocular visual acuity loss (visual harm). Benefits Patients: Personalised risk prediction for surgical complication or adverse acuity outcome based on individual risk factor profile; more relevant preoperative consenting. NHS: Ensure most experienced surgeons operate on high risk cases; ability to assess case-mix adjusted outcomes of surgeons for revalidation. WP3: A cohort study of 1500 people undergoing cataract surgery Predicting Visual Benefit Quantification of indicators for Cat-PROM self-reported benefit from cataract surgery (favourable and less favourable outcomes). Known and suspected predictors of benefit from cataract surgery will be assessed in relation to pre- and postoperative Cat-PROM self-reports. Patients approaching cataract surgery recruited to undergo enhanced research clinic preoperative assessment. Detailed phenotypic profiling to include known and suspected indicators of outcome variation. Cat-PROM used as the primary postoperative outcome measure. Predictors of levels of benefit investigated with statistical modelling. Benefits Patients: Personalised prediction of expected self-reported benefit based on a visual disability measure of direct relevance to patients. NHS: Patient centred measures of benefit in people undergoing cataract surgery; predictors of surgical benefit. Decision-Support From the statistical models for prediction of benefit, surgical complications and visual loss/harm, integrated calculator tools constructed for personalised predictions based on patients individual risk factor profiles. Calculator outputs referenced in patient decision-support Option Grids formatted as frequently asked questions (FAQ). Benefits Patient: Accessible decision-support information with personalised prediction of likely self-reported visual benefit, intraoperative complications and visual harm from cataract surgery. NHS: Better informed patients able to make informed choices regardi
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