Title: Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract SurgeryFHIR Id: Cataracts2040BCVAwithin90DaysFHIR Download cql: Cataracts2040BCVAwithin90DaysFHIR.cql Version: 0.0.007 Url: Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract SurgeryFHIR short-name identifier: CMS133FHIR version-independent identifier: urn:uuid:84905817-706b-48a8-a8f8-a05436cd6a0e version-specific identifier: urn:uuid:71bb8dc6-ca81-48a4-aa82-af4a0df0e92c endorser (NQF) identifier: 0565e publisher (CMS) identifier: 133FHIR Effective Period: 2024-01-01 ..2024-12-31 Status: draft Date: 2023-10-27 08:12:31+0000 Approval Date: 2023-08-14 Last Review Date: 2023-08-14 Name: Cataracts2040BCVAwithin90DaysFHIR Publisher: American Academy of Ophthalmology Author: American Academy of Ophthalmology: www.aao.org, American Medical Association (AMA): https://www.ama-assn.org/ 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 Use Context: code value program Purpose: UNKNOWN Copyright: Copyright 2023 American Academy of Ophthalmology. All Rights Reserved. Disclaimer: The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measure require a license agreement between the user and the American Academy of Ophthalmology (Academy). Neither the Academy, PCPI, nor the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor their members shall be responsible for any use of the Measure. The PCPI’s and AMA’s significant past efforts and contributions to the development and updating of the Measures are acknowledged. The National Committee for Quality Assurance’s significant past efforts and contributions to the development and updating of the Measure is acknowledged. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party’s use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measures. Any other use of CPT or other coding by the third party is strictly prohibited. The Academy, its members, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) is copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2022 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R]. Rationale: 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. 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. 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. Clinical recommendation statement: This is an outcome measure. As such, there is no statement in the guideline specific to this measurement topic. Guidance (Usage): 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 FHIR-based measure has been derived from the QDM-based measure: CMS133v12. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html). Population Criteria: 64529e07beb771640fc4cc00 Initial Population: All cataract surgeries performed between January and September of the measurement period for patients 18 years and older Denominator: Equals Initial Population Denominator Exclusion: Cataract surgeries in patients with significant ocular conditions impacting the visual outcome of surgery 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 Numerator Exclusion: None Denominator Exception: None Supplemental Data Guidance : Supplemental Data Elements: SDE Payer SDE Ethnicity SDE Race SDE Sex Libraries: Cataracts2040BCVAwithin90DaysFHIR Related Artifact Dependencies: SupplementalDataElements version: 3.4.000 QICoreCommon version: 1.5.000 FHIRHelpers version: 4.3.000 http://hl7.org/fhir/v3/AdministrativeGender SNOMED CT (all versions) Condition Clinical Status Codes Cataract Surgery Best Corrected Visual Acuity Exam Using Snellen Chart Visual Acuity 20/40 or Better Payer Acute and Subacute Iridocyclitis Amblyopia Burn Confined to Eye and Adnexa Cataract Secondary to Ocular Disorders Cataract, Congenital Cataract, Mature or Hypermature Cataract, Posterior Polar Central Corneal Ulcer Certain Types of Iridocyclitis Choroidal Degenerations Choroidal Detachment Choroidal Hemorrhage and Rupture Chronic Iridocyclitis Cloudy Cornea Corneal Edema Corneal Opacity and Other Disorders of Cornea 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 Glaucoma Associated with Congenital Anomalies, Dystrophies, and Systemic Syndromes Hereditary Choroidal Dystrophies Hereditary Corneal Dystrophies Hereditary Retinal Dystrophies Hypotony of Eye Injury to Optic Nerve and Pathways Macular Scar of Posterior Polar Morgagnian Cataract Nystagmus and Other Irregular Eye Movements Open Wound of Eyeball Optic Atrophy Optic Neuritis Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis Other Background Retinopathy and Retinal Vascular Changes Other Disorders of Optic Nerve Other Endophthalmitis Other Proliferative Retinopathy 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 Visual Field Defects Parameters: name use min max type Measurement Period In 0 1 Period SDE Sex Out 0 1 Coding Numerator Out 0 * Resource Denominator Out 0 * Resource SDE Payer Out 0 * Resource Initial Population Out 0 * Resource SDE Ethnicity Out 0 1 Resource Denominator Exclusions Out 0 * Resource SDE Race Out 0 1 Resource DataRequirements: Type Elements Valueset Name Valueset Patient(QICorePatient) ethnicity race Procedure(QICoreProcedure) code performed status status.value Cataract Surgery Cataract Surgery Observation(QICoreObservation) code effective status status.value value Observation(QICoreObservation) code effective status status.value value Best Corrected Visual Acuity Exam Using Snellen Chart Best Corrected Visual Acuity Exam Using Snellen Chart Coverage(QICoreCoverage) type period Payer Type Payer Condition(QICoreCondition) code Acute and Subacute Iridocyclitis Acute and Subacute Iridocyclitis Condition(QICoreCondition) code Amblyopia Amblyopia Condition(QICoreCondition) code Burn Confined to Eye and Adnexa Burn Confined to Eye and Adnexa Condition(QICoreCondition) code Cataract Secondary to Ocular Disorders Cataract Secondary to Ocular Disorders Condition(QICoreCondition) code Cataract Congenital Cataract, Congenital Condition(QICoreCondition) code Cataract Mature or Hypermature Cataract, Mature or Hypermature Condition(QICoreCondition) code Cataract Posterior Polar Cataract, Posterior Polar Condition(QICoreCondition) code Central Corneal Ulcer Central Corneal Ulcer Condition(QICoreCondition) code Certain Types of Iridocyclitis Certain Types of Iridocyclitis Condition(QICoreCondition) code Choroidal Degenerations Choroidal Degenerations Condition(QICoreCondition) code Choroidal Detachment Choroidal Detachment Condition(QICoreCondition) code Choroidal Hemorrhage and Rupture Choroidal Hemorrhage and Rupture Condition(QICoreCondition) code Chronic Iridocyclitis Chronic Iridocyclitis Condition(QICoreCondition) code Cloudy Cornea Cloudy Cornea Condition(QICoreCondition) code Corneal Edema Corneal Edema Condition(QICoreCondition) code Disorders of Cornea Including Corneal Opacity Corneal Opacity and Other Disorders of Cornea Condition(QICoreCondition) code Degeneration of Macula and Posterior Pole Degeneration of Macula and Posterior Pole Condition(QICoreCondition) code Degenerative Disorders of Globe Degenerative Disorders of Globe Condition(QICoreCondition) code Diabetic Macular Edema Diabetic Macular Edema Condition(QICoreCondition) code Diabetic Retinopathy Diabetic Retinopathy Condition(QICoreCondition) code Disorders of Optic Chiasm Disorders of Optic Chiasm Condition(QICoreCondition) code Disorders of Visual Cortex Disorders of Visual Cortex Condition(QICoreCondition) code Disseminated Chorioretinitis and Disseminated Retinochoroiditis Disseminated Chorioretinitis and Disseminated Retinochoroiditis Condition(QICoreCondition) code Focal Chorioretinitis and Focal Retinochoroiditis Focal Chorioretinitis and Focal Retinochoroiditis Condition(QICoreCondition) code Glaucoma Glaucoma Condition(QICoreCondition) code Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes Glaucoma Associated with Congenital Anomalies, Dystrophies, and Systemic Syndromes Condition(QICoreCondition) code Hereditary Choroidal Dystrophies Hereditary Choroidal Dystrophies Condition(QICoreCondition) code Hereditary Corneal Dystrophies Hereditary Corneal Dystrophies Condition(QICoreCondition) code Hereditary Retinal Dystrophies Hereditary Retinal Dystrophies Condition(QICoreCondition) code Hypotony of Eye Hypotony of Eye Condition(QICoreCondition) code Injury to Optic Nerve and Pathways Injury to Optic Nerve and Pathways Condition(QICoreCondition) code Macular Scar of Posterior Polar Macular Scar of Posterior Polar Condition(QICoreCondition) code Morgagnian Cataract Morgagnian Cataract Condition(QICoreCondition) code Nystagmus and Other Irregular Eye Movements Nystagmus and Other Irregular Eye Movements Condition(QICoreCondition) code Open Wound of Eyeball Open Wound of Eyeball Condition(QICoreCondition) code Optic Atrophy Optic Atrophy Condition(QICoreCondition) code Optic Neuritis Optic Neuritis Condition(QICoreCondition) code Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis Condition(QICoreCondition) code Other Background Retinopathy and Retinal Vascular Changes Other Background Retinopathy and Retinal Vascular Changes Condition(QICoreCondition) code Other Disorders of Optic Nerve Other Disorders of Optic Nerve Condition(QICoreCondition) code Other Endophthalmitis Other Endophthalmitis Condition(QICoreCondition) code Other Proliferative Retinopathy Other Proliferative Retinopathy Condition(QICoreCondition) code Pathologic Myopia Pathologic Myopia Condition(QICoreCondition) code Posterior Lenticonus Posterior Lenticonus Condition(QICoreCondition) code Prior Penetrating Keratoplasty Prior Penetrating Keratoplasty Condition(QICoreCondition) code Purulent Endophthalmitis Purulent Endophthalmitis Condition(QICoreCondition) code Retinal Detachment with Retinal Defect Retinal Detachment with Retinal Defect Condition(QICoreCondition) code Retinal Vascular Occlusion Retinal Vascular Occlusion Condition(QICoreCondition) code Retrolental Fibroplasias Retrolental Fibroplasias Condition(QICoreCondition) code Scleritis Scleritis Condition(QICoreCondition) code Separation of Retinal Layers Separation of Retinal Layers Condition(QICoreCondition) code Traumatic Cataract Traumatic Cataract Condition(QICoreCondition) code Uveitis Uveitis Condition(QICoreCondition) code Vascular Disorders of Iris and Ciliary Body Vascular Disorders of Iris and Ciliary Body Condition(QICoreCondition) code Visual Field Defects Visual Field Defects Direct Reference Codes: display code system Male M http://hl7.org/fhir/v3/AdministrativeGender Female F http://hl7.org/fhir/v3/AdministrativeGender Best corrected visual acuity (observable entity) 419775003 http://snomed.info/sct active http://terminology.hl7.org/CodeSystem/condition-clinical recurrence http://terminology.hl7.org/CodeSystem/condition-clinical relapse http://terminology.hl7.org/CodeSystem/condition-clinical Logic Definitions: Group Scoring Population Criteria Expression 64529e07beb771640fc4cc00 Group scoring: proportion Initial Population define "Initial Population": "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed where AgeInYearsAt(date from start of "Measurement Period") >= 18 Denominator define "Denominator": "Initial Population" Denominator Exclusion define "Denominator Exclusions": "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed with ( [Condition: "Acute and Subacute Iridocyclitis"] union [Condition: "Amblyopia"] union [Condition: "Burn Confined to Eye and Adnexa"] union [Condition: "Cataract Secondary to Ocular Disorders"] union [Condition: "Cataract Congenital"] union [Condition: "Cataract Mature or Hypermature"] union [Condition: "Cataract Posterior Polar"] union [Condition: "Central Corneal Ulcer"] union [Condition: "Certain Types of Iridocyclitis"] union [Condition: "Choroidal Degenerations"] union [Condition: "Choroidal Detachment"] union [Condition: "Choroidal Hemorrhage and Rupture"] union [Condition: "Chronic Iridocyclitis"] union [Condition: "Cloudy Cornea"] union [Condition: "Corneal Edema"] union [Condition: "Disorders of Cornea Including Corneal Opacity"] union [Condition: "Degeneration of Macula and Posterior Pole"] union [Condition: "Degenerative Disorders of Globe"] union [Condition: "Diabetic Macular Edema"] union [Condition: "Diabetic Retinopathy"] union [Condition: "Disorders of Optic Chiasm"] union [Condition: "Disorders of Visual Cortex"] union [Condition: "Disseminated Chorioretinitis and Disseminated Retinochoroiditis"] union [Condition: "Focal Chorioretinitis and Focal Retinochoroiditis"] union [Condition: "Glaucoma"] union [Condition: "Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes"] union [Condition: "Hereditary Choroidal Dystrophies"] union [Condition: "Hereditary Corneal Dystrophies"] union [Condition: "Hereditary Retinal Dystrophies"] union [Condition: "Hypotony of Eye"] union [Condition: "Injury to Optic Nerve and Pathways"] union [Condition: "Macular Scar of Posterior Polar"] union [Condition: "Morgagnian Cataract"] union [Condition: "Nystagmus and Other Irregular Eye Movements"] union [Condition: "Open Wound of Eyeball"] union [Condition: "Optic Atrophy"] union [Condition: "Optic Neuritis"] union [Condition: "Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis"] union [Condition: "Other Background Retinopathy and Retinal Vascular Changes"] union [Condition: "Other Disorders of Optic Nerve"] union [Condition: "Other Endophthalmitis"] union [Condition: "Other Proliferative Retinopathy"] union [Condition: "Pathologic Myopia"] union [Condition: "Posterior Lenticonus"] union [Condition: "Prior Penetrating Keratoplasty"] union [Condition: "Purulent Endophthalmitis"] union [Condition: "Retinal Detachment with Retinal Defect"] union [Condition: "Retinal Vascular Occlusion"] union [Condition: "Retrolental Fibroplasias"] union [Condition: "Scleritis"] union [Condition: "Separation of Retinal Layers"] union [Condition: "Traumatic Cataract"] union [Condition: "Uveitis"] union [Condition: "Vascular Disorders of Iris and Ciliary Body"] union [Condition: "Visual Field Defects"] ) ComorbidDiagnosis such that ComorbidDiagnosis.prevalenceInterval ( ) overlaps before CataractSurgeryPerformed.performed.toInterval ( ) and ComorbidDiagnosis.isActive ( ) Numerator define "Numerator": "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed with ( [Observation: "Best corrected visual acuity (observable entity)"] union [Observation: "Best Corrected Visual Acuity Exam Using Snellen Chart"] ) VisualAcuityExamPerformed such that VisualAcuityExamPerformed.effective.toInterval ( ) 90 days or less after day of end of CataractSurgeryPerformed.performed.toInterval ( ) and VisualAcuityExamPerformed.status in { 'final', 'amended', 'corrected', 'preliminary' } and VisualAcuityExamPerformed.value as Concept in "Visual Acuity 20/40 or Better" Numerator Exclusion None Denominator Exception None Library Name Name SupplementalDataElements SDE Sex define "SDE Sex": case when Patient.gender = 'male' then "M" when Patient.gender = 'female' then "F" else null end Library Name Name Cataracts2040BCVAwithin90DaysFHIR SDE Sex define "SDE Sex": SDE."SDE Sex" Library Name Name Cataracts2040BCVAwithin90DaysFHIR Cataract Surgery Between January and September of Measurement Period define "Cataract Surgery Between January and September of Measurement Period": [Procedure: "Cataract Surgery"] CataractSurgery where CataractSurgery.performed.toInterval ( ) during "Measurement Period" and CataractSurgery.performed.toInterval ( ) starts 92 days or more before end of "Measurement Period" and CataractSurgery.status = 'completed' Library Name Name Cataracts2040BCVAwithin90DaysFHIR Numerator define "Numerator": "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed with ( [Observation: "Best corrected visual acuity (observable entity)"] union [Observation: "Best Corrected Visual Acuity Exam Using Snellen Chart"] ) VisualAcuityExamPerformed such that VisualAcuityExamPerformed.effective.toInterval ( ) 90 days or less after day of end of CataractSurgeryPerformed.performed.toInterval ( ) and VisualAcuityExamPerformed.status in { 'final', 'amended', 'corrected', 'preliminary' } and VisualAcuityExamPerformed.value as Concept in "Visual Acuity 20/40 or Better" Library Name Name Cataracts2040BCVAwithin90DaysFHIR Initial Population define "Initial Population": "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed where AgeInYearsAt(date from start of "Measurement Period") >= 18 Library Name Name Cataracts2040BCVAwithin90DaysFHIR Denominator define "Denominator": "Initial Population" Library Name Name SupplementalDataElements SDE Payer define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period } Library Name Name Cataracts2040BCVAwithin90DaysFHIR SDE Payer define "SDE Payer": SDE."SDE Payer" Library Name Name SupplementalDataElements SDE Ethnicity define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text } Library Name Name Cataracts2040BCVAwithin90DaysFHIR SDE Ethnicity define "SDE Ethnicity": SDE."SDE Ethnicity" Library Name Name Cataracts2040BCVAwithin90DaysFHIR Denominator Exclusions define "Denominator Exclusions": "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed with ( [Condition: "Acute and Subacute Iridocyclitis"] union [Condition: "Amblyopia"] union [Condition: "Burn Confined to Eye and Adnexa"] union [Condition: "Cataract Secondary to Ocular Disorders"] union [Condition: "Cataract Congenital"] union [Condition: "Cataract Mature or Hypermature"] union [Condition: "Cataract Posterior Polar"] union [Condition: "Central Corneal Ulcer"] union [Condition: "Certain Types of Iridocyclitis"] union [Condition: "Choroidal Degenerations"] union [Condition: "Choroidal Detachment"] union [Condition: "Choroidal Hemorrhage and Rupture"] union [Condition: "Chronic Iridocyclitis"] union [Condition: "Cloudy Cornea"] union [Condition: "Corneal Edema"] union [Condition: "Disorders of Cornea Including Corneal Opacity"] union [Condition: "Degeneration of Macula and Posterior Pole"] union [Condition: "Degenerative Disorders of Globe"] union [Condition: "Diabetic Macular Edema"] union [Condition: "Diabetic Retinopathy"] union [Condition: "Disorders of Optic Chiasm"] union [Condition: "Disorders of Visual Cortex"] union [Condition: "Disseminated Chorioretinitis and Disseminated Retinochoroiditis"] union [Condition: "Focal Chorioretinitis and Focal Retinochoroiditis"] union [Condition: "Glaucoma"] union [Condition: "Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes"] union [Condition: "Hereditary Choroidal Dystrophies"] union [Condition: "Hereditary Corneal Dystrophies"] union [Condition: "Hereditary Retinal Dystrophies"] union [Condition: "Hypotony of Eye"] union [Condition: "Injury to Optic Nerve and Pathways"] union [Condition: "Macular Scar of Posterior Polar"] union [Condition: "Morgagnian Cataract"] union [Condition: "Nystagmus and Other Irregular Eye Movements"] union [Condition: "Open Wound of Eyeball"] union [Condition: "Optic Atrophy"] union [Condition: "Optic Neuritis"] union [Condition: "Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis"] union [Condition: "Other Background Retinopathy and Retinal Vascular Changes"] union [Condition: "Other Disorders of Optic Nerve"] union [Condition: "Other Endophthalmitis"] union [Condition: "Other Proliferative Retinopathy"] union [Condition: "Pathologic Myopia"] union [Condition: "Posterior Lenticonus"] union [Condition: "Prior Penetrating Keratoplasty"] union [Condition: "Purulent Endophthalmitis"] union [Condition: "Retinal Detachment with Retinal Defect"] union [Condition: "Retinal Vascular Occlusion"] union [Condition: "Retrolental Fibroplasias"] union [Condition: "Scleritis"] union [Condition: "Separation of Retinal Layers"] union [Condition: "Traumatic Cataract"] union [Condition: "Uveitis"] union [Condition: "Vascular Disorders of Iris and Ciliary Body"] union [Condition: "Visual Field Defects"] ) ComorbidDiagnosis such that ComorbidDiagnosis.prevalenceInterval ( ) overlaps before CataractSurgeryPerformed.performed.toInterval ( ) and ComorbidDiagnosis.isActive ( ) Library Name Name SupplementalDataElements SDE Race define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text } Library Name Name Cataracts2040BCVAwithin90DaysFHIR SDE Race define "SDE Race": SDE."SDE Race" Library Name Name QICoreCommon toInterval /* @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval @comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible representations for timing-valued elements in QICore, allowing this function to be used across any resource. The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>. The intent of this function is to provide a clear and concise mechanism to treat single elements that have multiple possible representations as intervals so that logic doesn't have to account for the variability. More complex calculations (such as medication request period or dispense period calculation) need specific guidance and consideration. That guidance may make use of this function, but the focus of this function is on single element calculations where the semantics are unambiguous. If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime. If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age, and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later. If the input is a DateTime Interval, the result is the input. If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending immediately before one year later than the date the patient turned the age given as the end of the quantity interval. Any other input will reslt in a null DateTime Interval */ define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>>): case when choice is DateTime then Interval[choice as DateTime, choice as DateTime] when choice is Interval<DateTime> then choice as Interval<DateTime> when choice is Quantity then Interval[Patient.birthDate + (choice as Quantity), Patient.birthDate + (choice as Quantity) + 1 year) when choice is Interval<Quantity> then Interval[Patient.birthDate + (choice.low as Quantity), Patient.birthDate + (choice.high as Quantity) + 1 year) else null as Interval<DateTime> end Library Name Name FHIRHelpers ToString define function ToString(value uri): value.value Library Name Name FHIRHelpers ToCode /* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value } Library Name Name QICoreCommon prevalenceInterval /* @description: Returns an interval representing the normalized prevalence period of a given Condition. @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. If the condition is active, the resulting interval will have a closed ending boundary. If the condition is not active, the resulting interval will have an open ending boundary. */ define fluent function prevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()] else Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()) Library Name Name QICoreCommon isActive /* Candidates for FHIRCommon */ /* @description: Returns true if the given condition has a clinical status of active, recurrence, or relapse */ define fluent function isActive(condition Condition): condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse"
Best corrected visual acuity (observable entity)
define "SDE Sex": case when Patient.gender = 'male' then "M" when Patient.gender = 'female' then "F" else null end
Cataract Surgery Between January and September of Measurement Period
define "Cataract Surgery Between January and September of Measurement Period": [Procedure: "Cataract Surgery"] CataractSurgery where CataractSurgery.performed.toInterval ( ) during "Measurement Period" and CataractSurgery.performed.toInterval ( ) starts 92 days or more before end of "Measurement Period" and CataractSurgery.status = 'completed'
define "Numerator": "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed with ( [Observation: "Best corrected visual acuity (observable entity)"] union [Observation: "Best Corrected Visual Acuity Exam Using Snellen Chart"] ) VisualAcuityExamPerformed such that VisualAcuityExamPerformed.effective.toInterval ( ) 90 days or less after day of end of CataractSurgeryPerformed.performed.toInterval ( ) and VisualAcuityExamPerformed.status in { 'final', 'amended', 'corrected', 'preliminary' } and VisualAcuityExamPerformed.value as Concept in "Visual Acuity 20/40 or Better"
define "Initial Population": "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed where AgeInYearsAt(date from start of "Measurement Period") >= 18
define "Denominator": "Initial Population"
define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period }
define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text }
define "SDE Ethnicity": SDE."SDE Ethnicity"
define "Denominator Exclusions": "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed with ( [Condition: "Acute and Subacute Iridocyclitis"] union [Condition: "Amblyopia"] union [Condition: "Burn Confined to Eye and Adnexa"] union [Condition: "Cataract Secondary to Ocular Disorders"] union [Condition: "Cataract Congenital"] union [Condition: "Cataract Mature or Hypermature"] union [Condition: "Cataract Posterior Polar"] union [Condition: "Central Corneal Ulcer"] union [Condition: "Certain Types of Iridocyclitis"] union [Condition: "Choroidal Degenerations"] union [Condition: "Choroidal Detachment"] union [Condition: "Choroidal Hemorrhage and Rupture"] union [Condition: "Chronic Iridocyclitis"] union [Condition: "Cloudy Cornea"] union [Condition: "Corneal Edema"] union [Condition: "Disorders of Cornea Including Corneal Opacity"] union [Condition: "Degeneration of Macula and Posterior Pole"] union [Condition: "Degenerative Disorders of Globe"] union [Condition: "Diabetic Macular Edema"] union [Condition: "Diabetic Retinopathy"] union [Condition: "Disorders of Optic Chiasm"] union [Condition: "Disorders of Visual Cortex"] union [Condition: "Disseminated Chorioretinitis and Disseminated Retinochoroiditis"] union [Condition: "Focal Chorioretinitis and Focal Retinochoroiditis"] union [Condition: "Glaucoma"] union [Condition: "Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes"] union [Condition: "Hereditary Choroidal Dystrophies"] union [Condition: "Hereditary Corneal Dystrophies"] union [Condition: "Hereditary Retinal Dystrophies"] union [Condition: "Hypotony of Eye"] union [Condition: "Injury to Optic Nerve and Pathways"] union [Condition: "Macular Scar of Posterior Polar"] union [Condition: "Morgagnian Cataract"] union [Condition: "Nystagmus and Other Irregular Eye Movements"] union [Condition: "Open Wound of Eyeball"] union [Condition: "Optic Atrophy"] union [Condition: "Optic Neuritis"] union [Condition: "Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis"] union [Condition: "Other Background Retinopathy and Retinal Vascular Changes"] union [Condition: "Other Disorders of Optic Nerve"] union [Condition: "Other Endophthalmitis"] union [Condition: "Other Proliferative Retinopathy"] union [Condition: "Pathologic Myopia"] union [Condition: "Posterior Lenticonus"] union [Condition: "Prior Penetrating Keratoplasty"] union [Condition: "Purulent Endophthalmitis"] union [Condition: "Retinal Detachment with Retinal Defect"] union [Condition: "Retinal Vascular Occlusion"] union [Condition: "Retrolental Fibroplasias"] union [Condition: "Scleritis"] union [Condition: "Separation of Retinal Layers"] union [Condition: "Traumatic Cataract"] union [Condition: "Uveitis"] union [Condition: "Vascular Disorders of Iris and Ciliary Body"] union [Condition: "Visual Field Defects"] ) ComorbidDiagnosis such that ComorbidDiagnosis.prevalenceInterval ( ) overlaps before CataractSurgeryPerformed.performed.toInterval ( ) and ComorbidDiagnosis.isActive ( )
define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text }
/* @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval @comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible representations for timing-valued elements in QICore, allowing this function to be used across any resource. The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>. The intent of this function is to provide a clear and concise mechanism to treat single elements that have multiple possible representations as intervals so that logic doesn't have to account for the variability. More complex calculations (such as medication request period or dispense period calculation) need specific guidance and consideration. That guidance may make use of this function, but the focus of this function is on single element calculations where the semantics are unambiguous. If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime. If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age, and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later. If the input is a DateTime Interval, the result is the input. If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending immediately before one year later than the date the patient turned the age given as the end of the quantity interval. Any other input will reslt in a null DateTime Interval */ define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>>): case when choice is DateTime then Interval[choice as DateTime, choice as DateTime] when choice is Interval<DateTime> then choice as Interval<DateTime> when choice is Quantity then Interval[Patient.birthDate + (choice as Quantity), Patient.birthDate + (choice as Quantity) + 1 year) when choice is Interval<Quantity> then Interval[Patient.birthDate + (choice.low as Quantity), Patient.birthDate + (choice.high as Quantity) + 1 year) else null as Interval<DateTime> end
define function ToString(value uri): value.value
/* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value }
/* @description: Returns an interval representing the normalized prevalence period of a given Condition. @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. If the condition is active, the resulting interval will have a closed ending boundary. If the condition is not active, the resulting interval will have an open ending boundary. */ define fluent function prevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()] else Interval[start of condition.onset.toInterval(), end of condition.abatementInterval())
/* Candidates for FHIRCommon */ /* @description: Returns true if the given condition has a clinical status of active, recurrence, or relapse */ define fluent function isActive(condition Condition): condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse"
Code system ConditionClinicalStatusCodes
Value set Best Corrected Visual Acuity Exam Using Snellen Chart
Value set Acute and Subacute Iridocyclitis
Value set Burn Confined to Eye and Adnexa
Value set Cataract Secondary to Ocular Disorders
Value set Cataract Mature or Hypermature
Value set Certain Types of Iridocyclitis
Value set Choroidal Hemorrhage and Rupture
Value set Disorders of Cornea Including Corneal Opacity
Value set Degeneration of Macula and Posterior Pole
Value set Degenerative Disorders of Globe
Value set Disseminated Chorioretinitis and Disseminated Retinochoroiditis
Value set Focal Chorioretinitis and Focal Retinochoroiditis
Value set Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes
Value set Hereditary Choroidal Dystrophies
Value set Hereditary Corneal Dystrophies
Value set Hereditary Retinal Dystrophies
Value set Injury to Optic Nerve and Pathways
Value set Macular Scar of Posterior Polar
Value set Nystagmus and Other Irregular Eye Movements
Value set Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis
Value set Other Background Retinopathy and Retinal Vascular Changes
Value set Other Disorders of Optic Nerve
Value set Other Proliferative Retinopathy
Value set Prior Penetrating Keratoplasty
Value set Retinal Detachment with Retinal Defect
Value set Vascular Disorders of Iris and Ciliary Body
Error attempting to determine filter value: toFhirValue not implemented for Subtract
Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract SurgeryFHIR
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
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 FHIR-based measure has been derived from the QDM-based measure: CMS133v12. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html).
Copyright 2023 American Academy of Ophthalmology. All Rights Reserved.
The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measure require a license agreement between the user and the American Academy of Ophthalmology (Academy). Neither the Academy, PCPI, nor the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor their members shall be responsible for any use of the Measure. The PCPI’s and AMA’s significant past efforts and contributions to the development and updating of the Measures are acknowledged. The National Committee for Quality Assurance’s significant past efforts and contributions to the development and updating of the Measure is acknowledged. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party’s use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measures. Any other use of CPT or other coding by the third party is strictly prohibited. The Academy, its members, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) is copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2022 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R].
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.
This is an outcome measure. As such, there is no statement in the guideline specific to this measurement topic.
All cataract surgeries performed between January and September of the measurement period for patients 18 years and older
Cataract surgeries in patients with significant ocular conditions impacting the visual outcome of 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