ESCRS - FP16.01 - A Systematic Literature Review Of Patient Reported Outcome Measures In Cataract Surgery

A Systematic Literature Review Of Patient Reported Outcome Measures In Cataract Surgery

Published 2026 - 44th Congress of the ESCRS

Reference: FP16.01 | Type: Free paper | DOI: 10.82333/sp9q-0k47

Authors: Dr Harry Rosen* 1 , Dr Jan-Willem Verstraaten 2 , Dr Rustu Emre Akcan 2 , Prof. Konrad Pesudovs 3 , Prof. Jos Kleijnen 4 , Prof. Mor Dickman 2

1University of Utrecht,Utrecht,Netherlands;Royal Hampshire County Hospital,Winchester,United Kingdom, 2University of Utrecht,Utrecht,Netherlands, 3University of New South Wales,Sydney,Australia, 4Kleijnen Systematic Reviews,York,United Kingdom

Purpose

 

This study was conducted by the ESCRS PROMs task-force group, a subsidiary to the ESCRS Registries working group. The primary purpose of this study was to Identify and assess the psychometric properties of PROMs used in cataract surgery, identify the gaps in the literature, and inform future recommendations for PROM development and implementation.

Secondary outcomes were to identify Patient Reported Outcomes (also referred to as constructs or domains) in cataract surgery and compare these against 14 previously recognised PROs.  Finally, to advance the field of methodological outcome measure assessment, using the example of cataract PROMs, by comparing two "gold-standard" frameworks for for PROM evaluation.

 

Setting

 

A literature project conducted under the umbrella of the ESCRS PROMs task-force, affiliated with the University of Utrecht.

 

Methods

 

  • A systematic literature search was conducted on 7 databases (MEDLINE(R), Embase (Ovid), Northern Light (ovid), CINAHL (EBSCO), CENTRAL (Wiley), CDSR (wiley), Pubmed in November 2024.
  • Data was extracted by three independent reviewers adhering to the COSMIN PRISMA checklist.
  • PROMs were evaluated for Risk of bias and sufficiency using both the COSMIN framework (2024) and the Pesudovs criteria for analysing PROM outcome measures.
  • Inclusion was limited to PROMs validated in cataract surgery populations only, with the exception of the NEI-VFQ family of questionnaires due to their ubiquitous use.

 

Results

 

  • 3823 studies were identified, refined to 226 studies psychometrically assessing properties of cataract PROMs.
  • 78 unique PROM variants were identified.
  • Vision related Activity Limitation (VRAL) was by far the most represented PRO.
  • There was a poor evidence base for content validity.
  • “Best in class” PROMs for each construct included: Catquest 9-SF for VRAL, ND-QOV and AIOLIS for visual symptoms, Cat-PROM5 for perceived visual dysfunction and NEI-VFQ LFSES for socio-economic concerns.
  • Targeting of many PROMs was inadequate.
  • The COSMIN framework was superior for systematic review methodology, Risk of bias assessment, and content validity. The Pesudovs criteria had greater clinical utility, assessment of Rasch properties, and useability.

 

Conclusions

 

  1. This work will guide the integration of high quality PROMs into the ESCRS registries.
  2. There is a need for contemporary content validity studies to identify relevant items for the “modern” cataract patient.
  3. This work could form the foundations for new PROM development or an item bank analysing the multiple PROs in cataract surgery
  4. Item banking would solve targeting and content validity issues, and allows the assessment of multiple PROs in the minimum amount of time.
  5. A qualitative inductive approach to re-evaluate PROs measured by cataract PROMs may be better than an a-priori matching to known PROs.
  6. Psychometric evaluation of the pilot AIOLIS questionnaire for symptoms and spectacle independence would be a useful contribution to the field.