Safe Eye Care

1
Safe Eye Care

• James C. Orcutt, MD, PhD
• National Program Director
• Ophthalmology

2
Wrong IOL/Wrong Eye

• VA contributed 35 of all cases in the VA that
  are reported (2001-2006)
• 23 Wrong Side
• 54 Wrong Implant
• 2010 Approximately 52,000 Cataract Surgeries
• 0.007 Wrong Side
• 0.01 Wrong Implant
• Not an excuse, any incidence is unacceptable

3
Recommended Safeguards

• Mandate Checklist
• Time Out
• Only one patient's lens in the room at one time
• Standardized process for pulling lens
• Review lens power when opening lens
• Review lens power prior to inserting lens

4
Cataract Surgery

• Most Common Procedure Performed in the VA
• 2010 52,000 Cataract Procedures
• Data Not Collected on Outcomes
• Not Included in NSQIP Data Collection
• Inability to Search EMR for Visual Outcomes
• 2008 Ophthalmology Surgery Outcomes Project
  (OSOD)

5
OSOD

• 5 Pilot Centers
• Nashville
• Boston
• Houston
• Saint Louis
• Philadelphia
• Templates
• Preoperative
• Operative
• Postoperative

6
Risk Stratification

• Preoperative Risk Factors
• Prior Trauma
• Flomax
• Operative Risk Factors
• Vitreous Loss
• Hemorrhage
• Postoperative Risk Factors
• High IOP
• Endophthalmitis

7
Outcome Measures

• Primary
• Quality of Life (NEI VFQ)
• Secondary
• Visual Acuity
• Endophthalmitis
• Death Within 30 Days

8
OSOD Status

• Approximately 1600 Cases Reported
• Denver VSQIP Statistical Center Support
• Statistical Relationship Between Risk Factors and
  Predicting Outcomes
• Reduce Data Collection to Pertinent Risk Factors
• Roll-out Across the VA 2012

9
Screening for Eye Disease

• Diabetic Screening
• Performance Measure
• 91 in 2010 (70 Benchmark)
• Teleretinal Imaging
• AMD
• Glaucoma