Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery
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| Measure Information | 2023 Performance Period | 2024 Performance Period | 2025 Performance Period | 2026 Performance Period |
|---|---|---|---|---|
| Title | Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery | Cataracts: 20 over 40 or Better Visual Acuity within 90 Days Following Cataract Surgery | Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery | Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery |
| CMS eCQM ID | CMS133v11 | CMS133v12 | CMS133v13 | CMS133v14 |
| CBE ID* | 0565e | 0565e | 0565e | 0565e |
| MIPS Quality ID | 191 | 191 | 191 | 191 |
| Measure Steward | American Academy of Ophthalmology | American Academy of Ophthalmology | American Academy of Ophthalmology | American Academy of Ophthalmology |
| Description |
Percentage of cataract surgeries for patients aged 18 and older with a diagnosis of uncomplicated cataract and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following the cataract surgery |
Percentage of cataract surgeries for patients aged 18 and older with a diagnosis of uncomplicated cataract and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following the cataract surgery |
Percentage of cataract surgeries for patients aged 18 and older with a diagnosis of uncomplicated cataract and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following the cataract surgery |
Percentage of cataract surgeries for patients aged 18 and older with a diagnosis of uncomplicated cataract and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following the cataract surgery |
| Measure Scoring | Proportion | Proportion | Proportion | Proportion |
| Measure Type | Outcome | Outcome | Outcome | Outcome |
| Stratification | *See CMS133v11.html |
None |
None |
None |
| Risk Adjustment | *See CMS133v11.html |
None |
None |
None |
| Rationale | *See CMS133v11.html |
In the United States, cataracts affect more than 24 million adults over 40 years (National Eye Institute, 2019). According to the American Academy of Ophthalmology (2021), cataract surgery has a substantial beneficial impact on visual function and on quality of life. 1. Scientific basis for measuring visual acuity outcomes after cataract surgery The only reason to perform cataract surgery (other than for a limited set of medical indications) is to improve a patient's vision and associated functioning. The use of a 20/40 visual acuity threshold is based on several considerations. First, it is the level for unrestricted operation of a motor vehicle in the US. Second, it has been consistently used by the FDA in its assessment for approval of intraocular lens (IOL) and other vision devices. Third, it is the literature standard to denote success in cataract surgery. Fourth, work by West et al. in the Salisbury Eye Study suggests that 20/40 is a useful threshold for 50th percentile functioning for several vision-related tasks. Most patients achieve excellent visual acuity after cataract surgery (20/40 or better). This outcome is achieved consistently through careful attention through the accurate measurement of axial length and corneal power and the appropriate selection of an IOL power calculation formula. As such, it reflects the care and diligence with which the surgery is assessed, planned and executed. Failure to achieve this after surgery in eyes without comorbid ocular conditions that would impact the success of the surgery would reflect care that should be assessed for opportunities for improvement. The exclusion of patients with other ocular and systemic conditions known to increase the risk of an adverse outcome reflects the findings of the two published prediction rule papers for cataract surgery outcomes, by Mangione et al. (1995) and Steinberg et al. (1994). In both papers, the presence of comorbid glaucoma and macular degeneration negatively impacted the likelihood of successful outcomes of surgery. Further, as noted in the prior indicator, exclusion of eyes with ocular conditions that could impact the success of the surgery would NOT eliminate the large majority of eyes undergoing surgery while also minimizing the potential adverse selection that might otherwise occur relative to those patients with the most complex situations who might benefit the most from having surgery to maximize their remaining vision. 2. Evidence of a gap in care Cataract surgery successfully restores vision in the majority of people who have the procedure. Data from a study of 368,256 cataract surgeries show that corrected visual acuity (CDVA) of 0.5 (20/40) or better was achieved in 94.3% and CDVA of 1.0 (20/20) or better was achieved in 61.3% of cases (Lundstrom, Barry, Henry, Rosen & Stenevi, 2013). Additionally, data from a UK multi-center Cataract National Dataset found a postoperative visual acuity of 6/12 (20/40) or better was achieved for 94.7% of eyes with no co-pathologies and in 79.9% of eyes with one or more co-pathologies (Jaycock et al., 2009).
A rate of 85.5-94.7% of patients achieving a 20/40 or better visual acuity in the context of approximately 3 million cataract surgeries in the US annually would mean that between 160,000 to 435,000 individuals would not achieve a 20/40 or better visual acuity which suggests an opportunity for improvement. |
In the United States, cataracts affect more than 24 million adults over 40 years (National Eye Institute, 2019). According to (Miller et al., 2022), cataract surgery has a substantial beneficial impact on visual function and on quality of life. 1. Scientific basis for measuring visual acuity outcomes after cataract surgery The only reason to perform cataract surgery (other than for a limited set of medical indications) is to improve a patient's vision and associated functioning. The use of a 20/40 visual acuity threshold is based on several considerations. First, it is the level for unrestricted operation of a motor vehicle in the US. Second, it has been consistently used by the Food and Drug Administration in its assessment for approval of intraocular lens (IOL) and other vision devices. Third, it is the literature standard to denote success in cataract surgery. Fourth, work by West et al. in the Salisbury Eye Study suggests that 20/40 is a useful threshold for 50th percentile functioning for several vision-related tasks. Most patients achieve excellent visual acuity after cataract surgery (20/40 or better). This outcome is achieved consistently through careful attention through the accurate measurement of axial length and corneal power and the appropriate selection of an IOL power calculation formula. As such, it reflects the care and diligence with which the surgery is assessed, planned and executed. Failure to achieve this after surgery in eyes without comorbid ocular conditions that would impact the success of the surgery would reflect care that should be assessed for opportunities for improvement. The exclusion of patients with other ocular and systemic conditions known to increase the risk of an adverse outcome reflects the findings of the two published prediction rule papers for cataract surgery outcomes, by Mangione et al. (1995) and Steinberg et al. (1994). In both papers, the presence of comorbid glaucoma and macular degeneration negatively impacted the likelihood of successful outcomes of surgery. Further, as noted in the prior indicator, exclusion of eyes with ocular conditions that could impact the success of the surgery would NOT eliminate the large majority of eyes undergoing surgery while also minimizing the potential adverse selection that might otherwise occur relative to those patients with the most complex situations who might benefit the most from having surgery to maximize their remaining vision. 2. Evidence of a gap in care Cataract surgery successfully restores vision in the majority of people who have the procedure. Data from a study of 368,256 cataract surgeries show that corrected visual acuity (CDVA) of 0.5 (20/40) or better was achieved in 94.3% and CDVA of 1.0 (20/20) or better was achieved in 61.3% of cases (Lundstrom et al., 2013). Additionally, data from a UK multi-center Cataract National Dataset found a postoperative visual acuity of 6/12 (20/40) or better was achieved for 94.7% of eyes with no co-pathologies and in 79.9% of eyes with one or more co-pathologies (Jaycock et al., 2009).
A rate of 85.5-94.7% of patients achieving a 20/40 or better visual acuity in the context of approximately 3 million cataract surgeries in the US annually would mean that between 160,000 to 435,000 individuals would not achieve a 20/40 or better visual acuity which suggests an opportunity for improvement. |
In the United States, cataracts affect more than 24 million adults over 40 years (National Eye Institute, 2019). According to (Miller et al., 2022), cataract surgery has a substantial beneficial impact on visual function and on quality of life. 1. Scientific basis for measuring visual acuity outcomes after cataract surgery The only reason to perform cataract surgery (other than for a limited set of medical indications) is to improve a patient's vision and associated functioning. The use of a 20/40 visual acuity threshold is based on several considerations. First, it is the level for unrestricted operation of a motor vehicle in the US. Second, it has been consistently used by the Food and Drug Administration in its assessment for approval of intraocular lens (IOL) and other vision devices. Third, it is the literature standard to denote success in cataract surgery. Fourth, work by West et al. in the Salisbury Eye Study suggests that 20/40 is a useful threshold for 50th percentile functioning for several vision-related tasks. Most patients achieve excellent visual acuity after cataract surgery (20/40 or better). This outcome is achieved consistently through careful attention through the accurate measurement of axial length and corneal power and the appropriate selection of an IOL power calculation formula. As such, it reflects the care and diligence with which the surgery is assessed, planned and executed. Failure to achieve this after surgery in eyes without comorbid ocular conditions that would impact the success of the surgery would reflect care that should be assessed for opportunities for improvement. The exclusion of patients with other ocular and systemic conditions known to increase the risk of an adverse outcome reflects the findings of the two published prediction rule papers for cataract surgery outcomes, by Mangione et al. (1995) and Steinberg et al. (1994). In both papers, the presence of comorbid glaucoma and macular degeneration negatively impacted the likelihood of successful outcomes of surgery. Further, as noted in the prior indicator, exclusion of eyes with ocular conditions that could impact the success of the surgery would NOT eliminate the large majority of eyes undergoing surgery while also minimizing the potential adverse selection that might otherwise occur relative to those patients with the most complex situations who might benefit the most from having surgery to maximize their remaining vision. 2. Evidence of a gap in care Cataract surgery successfully restores vision in the majority of people who have the procedure. Data from a study of 368,256 cataract surgeries show that corrected visual acuity (CDVA) of 0.5 (20/40) or better was achieved in 94.3% and CDVA of 1.0 (20/20) or better was achieved in 61.3% of cases (Lundstrom et al., 2013). Additionally, data from a UK multi-center Cataract National Dataset found a postoperative visual acuity of 6/12 (20/40) or better was achieved for 94.7% of eyes with no co-pathologies and in 79.9% of eyes with one or more co-pathologies (Jaycock et al., 2009).
A rate of 85.5-94.7% of patients achieving a 20/40 or better visual acuity in the context of approximately 3 million cataract surgeries in the US annually would mean that between 160,000 to 435,000 individuals would not achieve a 20/40 or better visual acuity which suggests an opportunity for improvement. |
| Clinical Recommendation Statement | *See CMS133v11.html |
This is an outcome measure. As such, there is no statement in the guideline specific to this measurement topic. |
This is an outcome measure. As such, there is no statement in the guideline specific to this measurement topic. |
This is an outcome measure. As such, there is no statement in the guideline specific to this measurement topic. |
| Improvement Notation |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
| Definition | *See CMS133v11.html |
None |
None |
None |
| Guidance |
This eCQM is an episode-based measure. An episode for this measure is defined as each cataract surgery during the measurement period, including instances where more than one cataract procedure was performed during the measurement period. Every cataract surgery during the measurement period should be counted as a measurable denominator event for the measure calculation.
Only procedures performed during January 1 - September 30 of the reporting period will be considered for this measure, in order to determine if 20/40 or better visual acuity has been achieved within the 90 days following the cataract procedure. Cataract procedures performed during October 1 - December 31 are excluded from the initial population. The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional or eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. This measure is to be reported by the clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure. Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible encounter codes. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
This eCQM is an episode-based measure. An episode for this measure is defined as each cataract surgery during the measurement period, including instances where more than one cataract procedure was performed during the measurement period. Every cataract surgery during the measurement period should be counted as a measurable denominator event for the measure calculation.
Only procedures performed during January 1 - September 30 of the reporting period will be considered for this measure, in order to determine if 20/40 or better visual acuity has been achieved within the 90 days following the cataract procedure. Cataract procedures performed during October 1 - December 31 are excluded from the initial population. The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional or eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. This measure is to be reported by the clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure. Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible encounter codes. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
This eCQM is an episode-based measure. An episode for this measure is defined as each cataract surgery during the measurement period, including instances where more than one cataract procedure was performed during the measurement period. Every cataract surgery during the measurement period should be counted as a measurable denominator event for the measure calculation.
Only procedures performed during January 1 - September 30 of the measurement period will be considered for this measure, in order to determine if 20/40 or better visual acuity has been achieved within the 90 days following the cataract procedure. Cataract procedures performed during October 1 - December 31 are excluded from the initial population. The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. This measure is to be reported by the clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure. Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible encounter codes. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
This eCQM is an episode-based measure. An episode for this measure is defined as each cataract surgery during the measurement period, including instances where more than one cataract procedure was performed during the measurement period. Every cataract surgery during the measurement period should be counted as a measurable denominator event for the measure calculation.
Only procedures performed during January 1 - September 30 of the measurement period will be considered for this measure, in order to determine if 20/40 or better visual acuity has been achieved within the 90 days following the cataract procedure. Cataract procedures performed during October 1 - December 31 are excluded from the initial population. The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. This measure is to be reported by the clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure. Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible encounter codes. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
| Initial Population |
All cataract surgeries for patients aged 18 years and older who did not meet any exclusion criteria |
All cataract surgeries performed between January and September of the measurement period for patients 18 years and older |
All cataract surgeries performed between January and September of the measurement period for patients 18 years and older |
All cataract surgeries performed between January and September of the measurement period for patients 18 years and older |
| Denominator |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
| Denominator Exclusions |
Cataract surgeries in patients with significant ocular conditions impacting the visual outcome of surgery |
Cataract surgeries in patients with significant ocular conditions impacting the visual outcome of surgery |
Cataract surgeries in patients with significant ocular conditions impacting the visual outcome of surgery |
Cataract surgeries in patients with significant ocular conditions impacting the visual outcome of surgery Significant ocular conditions include: amblyopia, burn confined to eye and adnexa, cataracts econdary to ocular disorders, congenital cataract, mature or hypermature cataract, posterior polar cataract, central corneal ulcer, certain types of iridocyclitis, choroidal degenerations, choroidal detachment, choroidal hemorrhage and rupture, cloudy cornea, corneal edema, disorders of cornea including corneal opacity, degeneration of macula and posterior pole, degenerative disorders of globe, diabetic macular edema, diabetic retinopathy disorders of optic chiasm, disorders of visual cortex, disseminated chorioretinitis and disseminated retinochoroiditis, focal chorioretinitis and focal retinochoroiditis, glaucoma, hereditary dystrophies (choroidal, corneal, retinal), hypotony of eye, injury to optic nerve and pathways, macular scare of posterior polar, morgagnian cataract, nystagmus and other irregular eye movements, open wound of eyeball, optic atrophy, optic neuritis, pathologic myopia, posterior lenticonus, prior penetrating keratoplasty, purulent endophthalmitis, retinal detachment with retinal defect, retinal vascular occlusion, retrolental fibroplasias, scleritis, separation of retinal layers, traumatic cataract, uveitis, vascular disorders of iris and ciliary body, and visual field defects |
| Numerator |
Cataract surgeries with best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following cataract surgery |
Cataract surgeries with best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following cataract surgery |
Cataract surgeries with best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following cataract surgery |
Cataract surgeries with best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following cataract surgery |
| Numerator Exclusions |
Not Applicable |
Not Applicable |
Not Applicable |
None |
| Denominator Exceptions |
None |
None |
None |
None |
| Telehealth Eligible | No | No | No | No |
| Next Version | No Version Available | |||
| Previous Version | No Version Available |
Additional Resources for CMS133v11
Header
Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
Updated disclaimer.
Measure Section: Disclaimer
Source of Change: Standards/Technical Update
Updated version number of the Quality Data Model (QDM) used in the measure specification to v5.6.
Measure Section: Guidance
Source of Change: Standards/Technical Update
Logic
Replaced the Global.CalendarAgeInYearsAt function with the native CQL function AgeInYearsAt to take advantage of existing CQL features and increase human readability. As a result of this change, the LOINC code 21112-8 is no longer required and has been removed from the Terminology section of the human readable specification.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v7.0.000.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Updated the version of the Quality Data Model (QDM) to 5.6 and Clinical Quality Language (CQL) to 1.5.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Value set
The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.
Value set Pathologic Myopia (2.16.840.1.113883.3.526.3.1432): Deleted 2 SNOMED CT codes (3712000, 193276002) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Optic Neuritis (2.16.840.1.113883.3.526.3.1467): Deleted 1 SNOMED CT code (314787009) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Injury to Optic Nerve and Pathways (2.16.840.1.113883.3.526.3.1427): Deleted 1 SNOMED CT code (230515007) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Visual Field Defects (2.16.840.1.113883.3.526.3.1446): Added 1 ICD-10-CM code (H53.47) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Retinal Detachment with Retinal Defect (2.16.840.1.113883.3.526.3.1478): Added 3 ICD-10-CM codes (H33.41, H33.42, H33.43) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis (2.16.840.1.113883.3.526.3.1468): Added 2 SNOMED CT codes (699515009, 699763005) based on terminology update. Deleted 1 SNOMED CT code (44674000) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Hereditary Corneal Dystrophies (2.16.840.1.113883.3.526.3.1424): Added 1 SNOMED CT code (231927007) based on terminology update. Deleted 1 SNOMED CT code (123670005) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes (2.16.840.1.113883.3.526.3.1461): Added 1 SNOMED CT code (1137633000) based on terminology update. Deleted 1 SNOMED CT code (404634005) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Focal Chorioretinitis and Focal Retinochoroiditis (2.16.840.1.113883.3.526.3.1460): Added 3 SNOMED CT codes (373667006, 699515009, 699763005) based on terminology update. Deleted 1 SNOMED CT code (44674000) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Degeneration of Macula and Posterior Pole (2.16.840.1.113883.3.526.3.1453): Added 1 SNOMED CT code (4041005) based on terminology update. Deleted 1 SNOMED CT code (204179007) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Uveitis (2.16.840.1.113883.3.526.3.1444): Deleted 2 SNOMED CT codes (95706000, 95707009) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set (2.16.840.1.113883.3.526.3.1461): Renamed to Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
Value set (2.16.840.1.113883.3.526.3.1414): Renamed to Cataract Posterior Polar based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
Value set (2.16.840.1.113883.3.526.3.1413): Renamed to Cataract Mature or Hypermature based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
Value set (2.16.840.1.113883.3.526.3.1412): Renamed to Cataract Congenital based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
Value set Glaucoma (2.16.840.1.113883.3.526.3.1423): Added 1 SNOMED CT code (15673041000119101) based on review by technical experts, SMEs, and/or public feedback. Added 2 SNOMED CT codes (1137633000, 1003657004) based on terminology update. Deleted 2 SNOMED CT codes (15673081000119106, 404634005) based on terminology update.
Measure Section: Terminology
Source of Change: Measure Lead
Removed direct reference code LOINC code (21112-8) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead