Assessment of Appropriateness of Cataract Surgery at Ten Academic Medical Centers in 1990

Published In: Ophthalmology, v. 103, Feb. 1996, p. 207-215

Posted on on January 01, 1996

by Joanne Tobacman, Paul Lee, Bridget Zimmerman, Hansjoerg Kolder, Lee H. Hilborne, Robert H. Brook

Develops criteria for the appropriateness of cataract surgery (extra-capsular cataract extraction or phacoemulsification with planned implantation of a posterior chamber intraocular lens) using a multidisciplinary expert panel and applied them to patients with cataract surgery from ten academic medical centers retrospectively. Approximately 2% of the procedures were classified as inappropriate, 91% as appropriate (52%) or appropriate and crucial (39%), and 7% as uncertain. Significant variation occurred in the results among the different institutions: inappropriate surgeries ranged from 0% to 4%, uncertain from 1% to 14%, appropriate from 35% to 66%, and appropriate and crucial from 21% to 62% (P = 0.02). A small percentage of cataract surgeries was performed at these ten academic medical centers for nappropriate indications according to the study criteria. Significant variation existed among the institutions in the distribution of appropriate and crucial and appropriate compared with uncertain and inappropriate surgeries.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.