• American Academy of Ophthalmology, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Eye care physician performance measurement set. Chicago (IL): American Medical Association, National Committee for Quality Assurance; 2007 Oct. 36 p. [42 references]

Does not apply to this measure

This measure is used to assess the percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) or their caregiver(s) who were counseled within 12 months on the benefits and/or risks of the Age-related Eye Disease Study (AREDS) formulation for preventing progression of AMD.

1. Scientific basis for counseling regarding use of Age-related Eye Disease Study (AREDS) formulation for patients with age-related macular degeneration (AMD)

   Antioxidant vitamins and mineral supplements help to reduce the rate of progression to advanced AMD for those patients with intermediate or advanced AMD in one eye. From the same AREDS study, there is no evidence that the use of antioxidant vitamin and mineral supplements for patients with mild AMD alters the natural history of mild AMD.

   At the same time, published meta analyses have raised an issue as to the presence of an elevated mortality risk among patients taking elements similar to parts of the AREDS formulation (and elevated risk among smokers). As such, patients need to know of their individualized risk profile for taking the AREDS formula AND the potential benefits, so that they can make their OWN individual decision as to whether or not to take the AREDS formulation.

   This indicator thus seeks to directly enhance the provider-patient relationship to apply the results of level 1 randomized controlled trials (RCTs) in a manner that accommodates the needs of each individual patient in a patient-centered manner, rather than a paternalistic approach of either recommending or withholding treatment.

2. Evidence of gap in care

   Antioxidant vitamins and mineral supplements help to reduce the rate of progression to advanced AMD for those patients with intermediate or advanced AMD in one eye. From the same AREDS study, there is no evidence that the use of antioxidant vitamin and mineral supplements for patients with mild AMD alters the natural history of mild AMD.

The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure:

Patients with intermediate AMD or advanced AMD in one eye should be counseled on the use of antioxidant vitamin and mineral supplements as recommended in the Age-related Eye Disease Study (AREDS) reports. (American Academy of Ophthalmology [AAO])

Table 1: Antioxidant Vitamin and Mineral Supplements Used in the AREDS

*These doses are not those listed on the commercially available vitamin/mineral supplements because of a change in labeling rules by the U.S. Food and Drug Administration that specifies that the doses must reflect the amounts available at the end of the shelf life.

SOURCE: A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E and beta carotene for age-related cataract and vision loss: AREDS report no. 9.

Age-related macular degeneration (AMD); patient/caregiver counseling (benefits and/or risks of the Age-related Eye Disease Study [AREDS] formulation)

All patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Patients with age-related macular degeneration (AMD) or their caregiver(s) who were counseled within 12 months on the benefits and/or risks of the Age-related Eye Disease Study (AREDS) formulation for preventing progression of AMD (see the related "Numerator Inclusions/Exclusions" field in the Complete Summary)

• A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence
• A systematic review of the clinical literature
• One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Unspecified

Current routine use

Internal quality improvement

Ambulatory Care
Physician Group Practices/Clinics

Physicians

Individual Clinicians

Age greater than or equal to 50 years

Either male or female

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

Getting Better

Effectiveness
Patient-centeredness

Users of care only

All patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD)

Patients associated with provider

Inclusions
All patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD)

Exclusions
Documentation of system reason(s) for not counseling on the benefits and/or risks of the Age-related Eye Disease Study (AREDS) formulation with the patient or caregiver(s)

All cases in the denominator are equally eligible to appear in the numerator

Clinical Condition
Encounter

Time window is a single point in time

Inclusions
Patients with age-related macular degeneration (AMD) or their caregiver(s) who were counseled within 12 months on the benefits and/or risks of the Age-related Eye Disease Study (AREDS) formulation for preventing progression of AMD

Note: This can be discussed with all patients with AMD, even those who do not meet the criteria for the AREDS formulation, patients who are smokers (beta-carotene can increase the risk for cancer in these patients) or other reasons why the patient would not meet criteria for AREDS formulation as outlined in the AREDS. The ophthalmologist or optometrist can explain why these supplements are not appropriate for their particular situation. Also, given the some of the purported risks associated with antioxidant use, patients would be informed of the risks and benefits and make their choice based on valuation of vision loss vs. other risks. As such, the measure seeks to educate patients about overuse as well as appropriate use.

Exclusions
None

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Fixed time period

Administrative data
Medical record

Individual Case

Unspecified

Rate

Better quality is associated with a higher score

Unspecified

Internal time comparison

Unspecified

Revised measure age-related macular degeneration (AMD): counseling on antioxidant supplement.

American Medical Association on behalf of the American Academy of Ophthalmology, Physician Consortium for Performance Improvement®, and National Committee for Quality Assurance

American Academy of Ophthalmology
National Committee for Quality Assurance
Physician Consortium for Performance Improvement®

Unspecified

Paul P. Lee, MD, JD (Co-Chair); Jinnet B. Fowles, PhD (Co-Chair)

Non-surgical Management Subgroup:

Richard L. Abbott, MD; Lloyd P. Aiello, MD, PhD; Murray Fingeret, OD; Andrea Gelzer, MD, MS, FACP; Mathew MacCumber, MD; Mildred M.G. Olivier, MD; Marcus G. Piccolo, OD; Sam J.W. Romeo, MD, MBA

Surgical Management Subgroup:

Priscilla P. Arnold, MD; Andrea Gelzer, MD, MS, FACP; Richard Hellman, MD, FACP, FACE; Leon W. Herndon, MD; Jeffrey S. Karlik, MD; James L. Rosenzweig, MD, FACE; John T. Thompson, MD

Flora Lum, MD, American Academy of Ophthalmology

Karen S. Kmetik, PhD, American Medical Association; Heidi Bossley, MSN, MBA, American Medical Association; Stephen Havas, MD, MPH, American Medical Association

Donna Pillittere, National Committee for Quality Assurance; Phil Renner, MBA, National Committee for Quality Assurance

Susan Nedza, MD, MBA, FACEP, Centers for Medicare & Medicaid Services; Sylvia Publ, MBA, RHIA, Centers for Medicare & Medicaid Services

Timothy F. Kresowik, MD, Facilitator; Rebecca A. Kresowik, Facilitator

Conflicts, if any, are disclosed in accordance with the Physician Consortium for Performance Improvement® conflict of interest policy.

National Quality Forum

Ambulatory Care Quality Alliance
Physician Quality Reporting Initiative

Measure was not adapted from another source.

2006 Oct

2007 Oct

This is the current release of the measure.

• American Academy of Ophthalmology, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Eye care physician performance measurement set. Chicago (IL): American Medical Association, National Committee for Quality Assurance; 2007 Oct. 36 p. [42 references]

This NQMC summary was completed by ECRI Institute on February 13, 2008. The information was verified by the measure developer on April 22, 2008.

© Measures including specifications © 2007 American Medical Association and National Committee for Quality Assurance.

CPT® Copyright 2006 American Medical Association