Cataract Surgery Success in Most Patients Defined by MIPS

Although surgeries to treat cataracts are deemed successful for most patients under the Merit-Based Incentive Payment System (MIPS) measure, the exclusion of nearly half of all patients, including older patients and Black patients, necessitates means of making the score fairer, according to a new study published in JAMA Ophthalmology.¹

The MIPS program is a measure used by CMS to assess the quality of eye care services across the country and can be used to evaluate the performance of clinicians, primarily aiming to encourage efficiency by providers and ensure quality care and lower costs.² The MIPS measure 191 is used to measure the quality of cataract surgery and excludes patients with comorbid chronic ocular diseases. This study aimed to assess how the outcomes of MIPS measure 191 could be affected by these exclusion criteria.

Data from 16 tertiary care health systems were used in this study. Electronic health record data from January 1, 2010, through December 31, 2023, were collected for all eye care recipients and deidentified. Patients were included if they were 18 years or older, had at least 1 visual acuity (VA) measurement in the operative eye within 90 days of surgery, and had undergone a cataract surgery.

Surgical success was the primary outcome of interest in this study. This was defined by MIPS measure 191 as at least 1 VA of at least 20/40 in the eye in the 90 days after surgery. Best-recorded VA (BRVA) was used for the assessment, with more stringent thresholds of 20/30, 20/25, and 20/20 also considered. The time period after surgery was also extended to 90, 180, and 365 days after surgery for the purpose of the analysis.

There were 55,132 patients who were included in the study, of which 58.5% were women and whose mean (SD) age was 70.3 (9.3) years. The majority of the population were White (76.5%) and covered by Medicare (58.8%); 25.7% were covered through commercial insurance. Nearly all patients lived in urban areas (96.7%).

The success rate of cataract surgery was 90.7% for 20/40 BRVA, 80.6% for 20/30, 69.0% for 20/25, and 55.8% for 20/20. After 180 days, these rates increased to 92.2%, 83.3%, 72.5%, and 60.0%, respectively. A year of follow-up found that these rates increased to 93.1%, 85.1%, 75.1%, and 63.6%, respectively.

A total of 72.7% of White patients had a BRVA of 20/60 or better before their surgery. Asian American (62.9%) and Black (64.8%) patients had lower percentages of eyes with 20/60 or better BRVA. A year after surgery, the BRVA of 20/25 or better was found in 44.9% of White patients, 39.4% of Asian American patients, and 33.9% of Black patients. A total of 32.3% of Hispanic patients had a BRVA of 20/25 a year after surgery compared with 42.9% of non-Hispanic patients.

Lower odds of success were found in patients of older age (OR per year, 0.98; 95% CI, 0.98-0.99). Patients in the highest income quartile had greater odds of success compared with the lowest quartile (OR, 1.15; 95% CI, 1.02-1.30). Patients using Medicare also had lower odds of success compared with those on commercial insurance (OR, 0.90; 95% CI, 0.82-0.99).

A total of 29,569 patients with no existing comorbid chronic ocular diseases were included in the secondary analysis, of which 60.4% were women and the mean age was 70.0 (8.8) years. A total of 95.5% of these patients achieved BRVAs of 20/40 or better, 87.7% achieved 20/30 or better, 77.0% achieved 20/25 or better, and 64.6% achieved 20/20 or better after 90 days. These rates increased to 96.9%, 91.1%, 82.2%, and 71.6%, respectively, after 1 year.

Asian American (OR, 1.63; 95% CI, 1.07-2.47) and Black (OR, 1.26; 95% CI, 1.02-1.56) patients had higher odds of success in this group. Medicaid recipients had lower odds of success (OR, 0.58; 95% CI, 0.40-0.83) compared with those on commercial insurance. Patients in the second, third, and fourth income quartiles had 35%, 23%, and 30% lower odds of success, respectively, compared with the top quartile. Older patients, Black patients, men, patients living with children, and patients with diabetes all had higher odds of having comorbid chronic ocular conditions.

There were some limitations to this study. SOURCE member sites were the only tertiary care health systems that were used to conduct the research, which makes generalizability to private practice or Veteran Affairs medical centers unknown. Outcomes of surgery could be negatively affected by the participation of surgical trainees. Only patients with complete sociodemographic data were included. Symptoms of glare, decline in activities of daily living, and reduced contrast sensitivity are other measures of success in cataract surgery that were not used for this analysis.

The MIPS score was found to have strengths in its measurement as well as places where the measure could improve. “We found that sociodemographic patient characteristics and clinical factors were associated with the likelihood of surgical success, highlighting the potential importance of case-mix adjustment,” the authors concluded.

References

1. Li Y, French DD, Chaudhury AS, et al. Evaluating metrics assessing surgical success in patients undergoing cataract surgery. JAMA Ophthalmol. Published online April 16, 2026. doi:10.1001/jamaophthalmol.2026.0845
2. Merit-based incentive payment system. American Academy of Ophthalmology. Accessed April 20, 2026. https://www.aao.org/advocacy/merit-based-incentive-payment-system