Improve Vision, Make Money

American Academy of Ophthalmology 2013

Melissa M. Brown, MD, MN, MBA


November 26, 2013

Editorial Collaboration

Medscape &

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In This Article

The Value of Cataract Surgery

Hello. I'm Dr. Melissa Brown. I am a research associate at Wills Eye Hospital in Philadelphia. I am also CEO of the Center for Value Based Medicine.

The Center for Value Based Medicine was started 10-15 years ago. It is a think tank in Philadelphia, and the doctors there look at medical economic data and do quality-of-life research as well as primary research with patients to be able to apply and evaluate what works in medicine and what doesn't work, because we can tell over the years that we are going to need that economic data. I want to make sure that my kids and now my grandkids have good healthcare, and unless we are able to show what works and what doesn't work with good data, it is going to be difficult to make sure that the healthcare system stays nice and strong.

Welcome to Medscape Ophthalmology Insights, coming from the American Academy of Ophthalmology (AAO) meeting in New Orleans. This is part of a series of commentaries produced in cooperation with Medscape and Wills Eye Hospital.

Today I will be talking about the value of cataract surgery within the foundation of value-based medicine. Value-based medicine is not complicated. It is very easy; it is the practice of medicine based on value. You have all heard about evidence-based medicine. This takes it one step higher, to the practice of medicine based on value. The value that we are looking at is patient value and financial value gained from medical interventions.

Usually when I talk about this topic, I have a nice big poster that shows 3 different blocks. The first block is evidence-based medicine. The second block is value, and the third is economic analyses. It is basically a flow chart. We start with evidence-based medicine, which is our clinical trials, like that being reported this week at the Academy. We have many great clinical trials that give us good data on what the different interventions can do. They don't tell us much about the value to individual patients. We take our evidence-based medicine, apply patient value to that, and then we look at the costs and figure out how much it costs to get this great value and whether it is really worth it. Is it a good thing? We know that we want to use interventions that have good value, but if you have interventions that are similar, we need to look at costs. When we look at patient value, we are looking at the improvement of length of life or quality of life (QOL), and in ophthalmology, for the most part we are looking at improving the QOL through improving vision.