eCQM Title

Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures

eCQM Identifier (Measure Authoring Tool) 132 eCQM Version number 7.2.000
NQF Number 0564 GUID 9a0339c2-3d9b-11e1-8634-00237d5bf174
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward PCPI(R) Foundation (PCPI[R])
Measure Developer American Medical Association (AMA)
Measure Developer PCPI(R) Foundation (PCPI[R])
Endorsed By National Quality Forum
Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and had any of a specified list of surgical procedures in the 30 days following cataract surgery which would indicate the occurrence of any of the following major complications: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence
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Measure Scoring Proportion
Measure Type Outcome
Risk Adjustment
Rate Aggregation
In the United States, cataracts affect more than 24 million adults over 40 years. (NEI, 2016) According to the American Academy of Ophthalmology (AAO), cataract surgery leads to favorable outcomes and improved vision. (AAO, 2016) Although uncommon, complications from cataract surgery do occur and may result in vision loss. (AAO, 2016) 

1. Scientific basis for assessing short-term complications following cataract surgery 
This short-term outcome of surgery indicator seeks to identify those complications from surgery that can reasonably be attributed to the surgery and surgeon and which reflect situations which - if untreated - generally result in significant avoidable vision loss that would negatively impact patient functioning. Further, it seeks to reduce surgeon burden and enhance accuracy in reporting by focusing on those significant complications that can be assessed from administrative data alone and which can be captured by the care of another physician or the provision of additional, separately coded, post-operative services. Finally, it focuses on patient safety and monitoring for events that, while hopefully uncommon, can signify important issues in the care being provided. For example, the need to reposition or exchange an intraocular lens (IOL) reflects in part "wrong power" IOL placement, a major patient safety issue.

In order to achieve these ends, the indicator excludes patients with other known, pre-operative ocular conditions that could impact the likelihood of developing a complication. Based on the results of the Cataract Appropriateness Project at RAND, other published studies, and one analysis performed on a national MCO data base, the exclusion codes would preserve over 2/3 of all cataract surgery cases for analysis. Thus, this provides a "clean" indicator that captures care for the large majority of patients undergoing cataract surgery.

2. Evidence for gap in care
The advances in technology and surgical skills over the last 30 years have made cataract surgery much safer and more effective although complications that threaten vision do occur. For example, a study of more than 220,000 Medicare beneficiaries who underwent cataract surgery between 1994 and 2006 found that more than 1,000, or about 0.5%, of patients had at least one severe post-operative complication. These severe complications were defined as endophthalmitis (0.16%), suprachoroidal hemorrhage (0.06%), and retinal detachment (0.26%). (Stein, 2011) 

In a review, Taban et al. found a postoperative rate of endophthalmitis of 0.128%. (Taban, 2005)

The occurrence of one of these events is associated with a significant potential for vision loss that is otherwise avoidable.
Clinical Recommendation Statement
This is an outcome measure. As such, there are no statements in the guideline specific to this measurement topic.
Improvement Notation
Lower score indicates better quality
National Eye Institute. Statistics and data: cataract. Reviewed April 2016. Accessed November 7, 2017. 
American Academy of Ophthalmology. Cataract in the adult eye preferred practice pattern. San Francisco, CA: American Academy of Ophthalmology; 2016.
Stein JD, Grossman DS, Mundy KM, et al. Severe adverse events after cataract surgery among Medicare beneficiaries. Ophthalmology. 2011;118(9):1716-23.
Taban M, Behrens A, Newcomb RL, et al. Acute endophthalmitis following cataract surgery: a systematic review of the literature. Arch Ophthalmol. 2005;123:613-620. 
This is an episode-based measure, meaning there may be more than one reportable event for a given patient during the measurement period.

The level of analysis for this measure is each cataract surgery during the measurement period. Every cataract surgery during the measurement period should be counted as a measurable denominator event for the measure calculation.  

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 ICD-9-CM and SNOMED-CT do 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.
Transmission Format
Initial Population
All patients aged 18 years and older who had cataract surgery and did not meet any exclusion criteria
Equals Initial Population
Denominator Exclusions
Patients with any one of a specified list of significant ocular conditions that impact the surgical complication rate
Patients who had one or more specified operative procedures for any of the following major complications within 30 days following cataract surgery: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence
Numerator Exclusions
Not Applicable
Denominator Exceptions
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Table of Contents

Population Criteria




Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables

Measure Set