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AGENCY FOR HEALTH CARE POLICY AND RESEARCH RELEASES CATARACT CARE GUIDELINE

 /ADVANCE/ WASHINGTON, Feb. 25 /PRNewswire/ -- Leading eye and health care experts said today that physicians and patients should not rush into cataract surgery if glasses or visual aids can provide satisfactory functional vision and the patient's lifestyle is not compromised.
 Cataract surgery is absolutely necessary only in the presence of diseases such as glaucoma and diabetic retinopathy, according to the members of a private-sector panel of experts whose recommendations were released today by the Agency for Health Care Policy and Research.
 About 1.35 million cataract surgeries were performed in 1991, at a cost of approximately $3.4 billion to Medicare alone. It is the most common surgical procedure among Americans over 65, and while younger people develop cataracts less frequently, they too require surgery at times. But the experts' guidelines encourage patients and opthamologists to consider such options as stronger glasses, magnifying lenses, pupil dilation and simply waiting until the cataract becomes more burdensome.
 The leader of the panel, Denis O'Day, M.D., said, "The operating surgeon and patient should discuss the risks and benefits of cataract surgery, and then weigh them against the degree to which a cataract interferes with daily activities. Ultimately, the decision must be made by the patient." O'Day chairs the department of ophthalmology at the Vanderbilt University School of Medicine.
 J. Jarrett Clinton, M.D., administrator of the sponsoring agency, a part of the U.S. Public Health Service within HHS, said that cataract surgery is low risk but not risk-free. "Not everyone who develops a cataract wants surgery, nor does everyone need it unless their quality of life is affected. Some may never need an operation."
 According to O'Day, currently there are no objective, independent measures of functional impairment that can serve as precise indications for surgery. The panel believes that the development of such measures should be a priority.
 The guidelines do not recommend cataract surgery solely to improve vision if:
 -- The patient does not desire surgery,
 -- Glasses or visual aids provide satisfactory functional vision,
 -- The patient's lifestyle is not compromised, or,
 -- The patient is medically unfit.
 The guidelines also emphasize the importance of post-operative care to cataract surgery outcome. The guidelines place responsibility for follow-up care on the operating surgeon and recommend defined roles and responsibilities for ophthalmologists, optometrists and other members of a team of appropriately trained professionals, including community health nurses and social workers.
 The panel reviewed nearly 8,000 published studies on cataract care as well as information provided by consultants, specialty societies and others. The draft guidelines were widely circulated to cataract experts for review and comment before they were made final.
 Included in the guidelines are findings from cataract outcomes published by a team of researchers on the incidence of retinal detachment after use of YAG-laser capsulotomy -- a procedure undergone annually by more than 600,000 previous cataract surgery patients to correct opaqueness of the remaining lens capsule. The study found that the procedure is associated with a nearly four-fold increase in the risk of retinal detachment. The AHCPR-funded cataract Patient Outcomes Research Team project, which is led by Earl Steinberg, M.D., of Johns Hopkins University, is examining variations in cataract treatment and short- and long-term outcomes and costs associated with cataracts.
 The cataract guidelines have been endorsed to date by the American Academy of Ophthalmology, Association of University Professors of Ophthalmology, American College of Surgeons, American Society of Ophthalmic Registered Nurses, National Society to Prevent Blindness and the Alliance for Aging Research.
 The guidelines are the fourth published by AHCPR, whose mission is to improve the effectiveness, quality and accessibility of health care. Sixteen other clinical practice guidelines, including ones on depression, HIV illness, cancer pain and low-back problems, are under development.
 Copies of "Cataract in Adults: Clinical Practice Guideline," an accompanying quick reference guide for clinicians, and a guide for patients, are available free from the AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, Md. 20907; or by calling 800-358-9295.
 -0- 2/25/93/1015
 /CONTACT: Bob Isquith of the Agency for Health Care Policy and Research, 301-227-8364, ext. 159/


CO: Agency for Health Care Policy and Research ST: District of Columbia IN: HEA SU:

KD-DC -- DC018 -- 0025 02/24/93 15:28 EST
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Date:Feb 24, 1993
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