Do patients and other stakeholders value health service quality equally? A prospect theory based choice experiment in cataract care.

OBJECTIVES: This study aims to compare the valuation of health service quality by patients and other stakeholders through a case study in cataract care. METHODS: The valuation of health service quality by Dutch patients, ophthalmologists and healthcare purchasers involved in cataract care are elicited by a prospect theory-based measurement task. Respondents stated preferences for probabilities and scores for the clinical indicator Complication (posterior capsular rupture with vitreous loss) and the patient-reported experience measure Information Provisioning (the ophthalmologist provides sufficient information about risks of cataract surgery to the patient). Our subject pool (n = 256) consisted of 90 ophthalmologists, 125 cataract patients, and 41 healthcare purchasers employed by health insurance companies. RESULTS: Following prospect theory, respondents were loss averse, and risk averse for gains. However, utilities differed from prospect theory, especially the concave utility for losses. Patients were significantly more loss averse than the other respondents, more subject to a pessimistic view on losses, and had significantly more concave utility for losses, especially for the clinical quality indicator Complications. For each of the stakeholders, the results differed significantly between the two essentially different quality indicators. CONCLUSIONS: The heterogeneous valuations of patients and other stakeholders invalidate commonly applied cataract care quality assessment frameworks. Incorporating loss aversion, pessimism and concave utility for losses can remedy existing shortcomings. The valuation differences between patients and other stakeholders emphasize the need for communication and shared decision making in patient-centered treatment, purchasing and policy.

Global multi-site, prospective analysis of cataract surgery outcomes following ICHOM standards: the European CAT-Community.

PURPOSE: To evaluate in a large sample of patients from 10 different European centers the results of cataract surgery, characterizing the relationship between patient-reported outcomes (PROMs) and clinician-reported outcome measures (CROMs). METHODS: Prospective non-interventional multicenter observational descriptive study analyzing the clinical outcomes of a total of 3799 cases undergoing cataract surgery (mean age: 72.7 years). In all cases, the cataract surgery standard developed by the International Consortium for Health Outcomes Measurements (ICHOM) was used to register the clinical data. Three-month postoperative visual acuity and refraction data were considered CROMs, whereas Rasch-calibrated item 2 (RCCQ2) and total Catquest-9SF score (CQ) were considered PROMs. RESULTS: Postoperative corrected distance visual acuity (CDVA) was 0.3 logMAR or better in 88.7% (2505/2823) of eyes. Mean differences between preoperative and postoperative RCCQ2 and CQ scores were -3.09 and -2.39, respectively. Visual function improvement with surgery was reported by 91.5% (2163/2364) of patients. Statistically significant, although weak, correlations of postoperative CDVA with postoperative refraction, PROMs, and complications were found (0.133 ≤ r ≤0.289, p < 0.001). A predictive model (R2: 0.254) of postoperative CDVA considering 10 variables was obtained, including preoperative CDVA, different ocular comorbidities, age, gender and intraoperative complications. Likewise, another predictive model (R2: 0.148) of postoperative CQ considering a total of 14 variables was obtained, including additionally preoperative CQ, target refraction and previous surgeries. CONCLUSIONS: Cataract surgery provides an improved functional vision in most of patients although this improvement can be limited by ocular comorbidities and complications. The relationship between PROMs and CROMs is multifactorial and complex.

Relative contribution of central and peripheral aberrations to overall high order corneal wavefront aberration.

PURPOSE: To analyze the influence of specific combinations of corneal high order aberrations on the optical image quality of the cornea before and after photorefractive keratectomy (PRK) for low to high myopia and myopic astigmatism. METHODS: Corneal topography was obtained for 80 eyes that underwent PRK using a scanning-spot excimer laser. The eyes were subdivided into three groups according to the preoperative refraction. The topographical data were imported into a custom software program that combined the Zernike high order terms having the same sign and angular frequency up to seventh order for 4-mm and 6-mm pupils, ie, coma and spherical aberrations, and midperipheral and peripheral high order aberrations. RESULTS: Photorefractive keratectomy induced a significant amount of the root-mean-square (RMS) values of the combinations of midperipheral and peripheral high order aberrations over the smaller pupil size for deeper myopic ablations (P<.05). Over the larger pupil, spherical myopic ablations showed a significant increase (P<.05) of the RMS values of coma and spherical aberrations. In the astigmatism group, the combination of terms having higher angular frequency increased significantly (P<.05) after surgery both over 4-mm and 6-mm pupils. CONCLUSIONS: After surface ablation, ablation depth and profile significantly influence the distribution and contribution of determined combinations of high order aberrations to the overall high order corneal wavefront aberration. Terms having high angular frequency were increased following large myopic correction and wide treatment zone. Quality of the whole corneal optics will be enhanced by designing future ablation profiles to compensate for peripheral high order optical aberrations.

Response of the cornea for up to four years after photorefractive keratectomy for myopia.

PURPOSE: To analyze the long-term corneal topographic changes 4 years after myopic photorefractive keratectomy (PRK). METHODS: This study comprised 15 patients (30 eyes) who had PRK surgery with a scanning-spot excimer laser (Chiron Technolas 217C; Bausch & Lomb, Dornach, Germany) and were followed up to 4 years after surgery. The eyes were subdivided into three groups according to the preoperative spherical equivalent refraction. Corneal topographic maps were obtained for all eyes with a Placido disc topographer. Preoperative and follow-up topographical data were imported into a custom software program, which computed the average composite corneal maps and difference maps for each study group to quantify the anterior corneal changes following laser ablation. The software delineated three concentric zones of the corneal surface to characterize the regional corneal remodeling following the surgery. RESULTS: A significant central corneal steepening (approximately 0.25 D, P < .001) was calculated between the 1- and 4-year postoperative maps in all study groups. A significant steepening (P < .001) of the corneal periphery was also noted for the lower myopic ablations whereas a peripheral flattening (P < .001) was observed for the deeper ablations between 1 and 4 years after surgery. CONCLUSIONS: The anterior corneal surface was observed to remodel for up to 4 years after surface ablation, steepening a mean of approximately 0.25 D.