Evaluating Metrics Assessing Surgical Success in Patients Undergoing Cataract Surgery

Importance: As health insurers, payers, and policymakers look to Merit-Based Incentive Payment System (MIPS) measures to judge eye care quality, compare surgeon performance, and make decisions about reimbursement, it is essential to understand the validity and generalizability of these metrics. Objective: To assess the validity and generalizability of 2024 MIPS measure 191, Cataracts: 20/40 or Better Visual Acuity Within 90 Days Following Cataract Surgery. Design, Setting, Participants: This was a retrospective cohort study of patients who underwent at least 1 cataract surgery from 2010 through 2023 at any of 16 participating health systems in the Sight Outcomes Research Collaborative (SOURCE). The study assessed whether patient demographic characteristics and nonclinical and clinical factors were associated with achieving success, which MIPS measure 191 defines as a best recorded visual acuity of at least 20/40 within 90 days following cataract surgery. Data analysis was conducted from June 2024 to December 2025. Exposures: Cataract surgery. Main Outcomes and Measures: The percentage of patients undergoing cataract surgery achieving success and the odds of surgical success were determined; for patients with 2 operative eyes, only the first eye surgery was assessed. Success rates were evaluated among all surgery recipients and separately among patients with no preexisting chronic ocular diseases as specified by the metric. Success rates were quantified using more stringent cutoffs and adjusting the follow-up duration. Logistic regression models assessed how nonbiological determinants of health and clinical factors influenced the odds of success. Results: A total of 55 132 patients underwent cataract surgery (mean [SD] age, 70.3 [9.3] years; 32 240 [58.5%] female; 1973 [3.6%] Asian American; 7053 [12.8%] Black; 1993 [3.6%] Hispanic; 42 178 [76.5%] White [race and ethnicity were self-reported]). Among all patients undergoing surgery, 49 979 (90.7%) achieved surgical success. Excluding patients with ocular comorbidities (25 563 patients [46.4%]), 28 242 of 29 569 (95.5%) achieved surgical success. Living in the least (vs most) affluent community (odds ratio [OR], 0.81; 95% CI, 0.72-0.91), undergoing complex surgery (OR, 0.82; 95% CI, 0.75-0.89) or a combination of cataract with another intraocular surgery (OR, 0.32; 95% CI, 0.29-0.35), and having diabetes (OR, 0.90; 95% CI, 0.84-0.98) were associated with lower odds of surgical success. Conclusions and Relevance: In this cohort study, most patients undergoing cataract surgery achieved success as defined by MIPS measure 191; however, the existing measure excluded nearly half of patients undergoing surgery, and older patients and Black patients were more likely to be excluded. Case-mix adjustment of patients' sociodemographic characteristics and clinical factors may be necessary to ensure fairness when comparing surgeons' performance.