Safe Eye Care James C. Orcutt, MD, PhD National Program Director Ophthalmology

Wrong IOL/Wrong Eye VA contributed 35% of all cases in the VA that are reported ( ) – 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

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

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)

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

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

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

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

Screening for Eye Disease Diabetic Screening – Performance Measure – 91% in 2010 (70% Benchmark) – Teleretinal Imaging AMD Glaucoma