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  • Measure Summary
  • NQMC:010178
  • Jan 2015
  • NQF-Endorsed Measure

Age-related macular degeneration (AMD): percentage of patients aged 50 years and older with a diagnosis of AMD who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or hemorrhage, AND the level of macular degeneration severity during one or more office visits within 12 months.

American Academy of Ophthalmology (AAO). Eye care quality measure: age-related macular degeneration: dilated macular examination. Version 9.1. San Francisco (CA): American Academy of Ophthalmology (AAO); 2015 Jan. 3 p.

This is the current release of the measure.

This measure updates a previous version: American Academy of Ophthalmology, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Eye care I physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2010 Sep. 12 p.

The measure developer reaffirmed the currency of this measure in December 2015.

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Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or hemorrhage, AND the level of macular degeneration severity during one or more office visits within 12 months.

Rationale

A documented complete macular examination is a necessary prerequisite to determine the presence and severity of age-related macular degeneration (AMD), so that a decision can be made as to the benefits of prescribing antioxidant vitamins. Further, periodic assessment is necessary to determine whether there is progression of the disease and to plan the on-going treatment of the disease, since several therapies exist that reduce vision loss once the advanced "wet" form of AMD occurs. While no data exist on the frequency or absence of regular examinations of the macula for patients with AMD, parallel data for key structural assessments for glaucoma, cataract and diabetic retinopathy suggest that significant gaps are likely.

Clinical Recommendation Statements:

According to the American Academy of Ophthalmology (AAO), a stereo biomicroscopic examination of the macula should be completed. Binocular slit-lamp biomicroscopy of the ocular fundus is often necessary to detect subtle clinical clues of choroidal neovascularization (CNV). These include small areas of hemorrhage, hard exudates, subretinal fluid, or pigment epithelial elevation (AAO, 2014).

Evidence for Rationale

American Academy of Ophthalmology (AAO). Eye care quality measure: age-related macular degeneration: dilated macular examination. Version 9.1. San Francisco (CA): American Academy of Ophthalmology (AAO); 2015 Jan. 3 p.

American Academy of Ophthalmology (AAO). Preferred Practice Patterns. Age-related macular degeneration. San Francisco (CA): American Academy of Ophthalmology (AAO); 2014.

Primary Health Components

Age-related macular degeneration (AMD); dilated macular examination; macular thickening or hemorrhage; macular degeneration

Denominator Description

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

Numerator Description

Patients who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or hemorrhage AND the level of macular degeneration severity during one or more office visits within 12 months (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Pay-for-reporting

Professional certification

Public reporting

Measurement Setting

Ambulatory/Office-based Care

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 50 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

The reporting period

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

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

Exclusions

  • Documentation of medical reason(s) for not performing a dilated macular examination
  • Documentation of patient reason(s) for not performing a dilated macular examination

Note: Refer to the original measure documentation for International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes.

Exclusions/Exceptions

Medical factors addressed

Patient factors addressed

Numerator Inclusions/Exclusions

Inclusions
Patients who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or hemorrhage AND the level of macular degeneration severity during one or more office visits within 12 months

Note:

  • Macular Thickening: Acceptable synonyms for "macular thickening" include: intraretinal thickening, serous detachment of the retina, pigment epithelial detachment or macular edema.
  • Severity of Macular Degeneration: Early, intermediate and advanced.

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Registry data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Age-related macular degeneration: dilated macular examination.

Measure Collection Name

Eye Care Quality Measures

Submitter

American Academy of Ophthalmology - Medical Specialty Society

Developer

American Academy of Ophthalmology - Medical Specialty Society

Funding Source(s)

American Academy of Ophthalmology (AAO)

Composition of the Group that Developed the Measure

  • Paul P. Lee, MD, JD (Co-Chair)
  • Jinnet B. Fowles, PhD (Co-Chair)
  • Richard L. Abbott, MD
  • Jeffrey S. Karlik, MD
  • Lloyd P. Aiello, MD PhD
  • Mathew W. MacCumber, MD, PhD
  • Priscilla P. Arnold, MD
  • Mildred M. G. Olivier, MD
  • Richard Hellman, MD, FACP, FACE
  • James L. Rosenzweig, MD, FACE
  • Leon W. Herndon, MD
  • Sam J. W. Romeo, MD, MBA
  • Kenneth J. Hoffer, MD
  • John T. Thompson, MD

Financial Disclosures/Other Potential Conflicts of Interest

None

Endorser

National Quality Forum

NQF Number

0087

Date of Endorsement

2014 Jan 30

Measure Initiative(s)

Physician Quality Reporting System

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Jan

Measure Maintenance

Reviewed and updated if appropriate on an annual cycle

Date of Next Anticipated Revision

2016

Measure Status

This is the current release of the measure.

This measure updates a previous version: American Academy of Ophthalmology, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Eye care I physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2010 Sep. 12 p.

The measure developer reaffirmed the currency of this measure in December 2015.

Source(s)

American Academy of Ophthalmology (AAO). Eye care quality measure: age-related macular degeneration: dilated macular examination. Version 9.1. San Francisco (CA): American Academy of Ophthalmology (AAO); 2015 Jan. 3 p.

Measure Availability

Source not available electronically.

For more information, contact the American Academy of Ophthalmology (AAO) at 655 Beach Street, San Francisco, CA 94109; Phone: 415-561-8500; Fax: 415-561-8533; Web site: www.aao.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on February 11, 2008. The information was verified by the measure developer on April 14, 2008.

This NQMC summary was edited by ECRI Institute on October 4, 2010.

This NQMC summary was retrofitted into the new template on May 18, 2011.

This NQMC summary was edited again by ECRI Institute on April 27, 2012.

This NQMC summary was updated by ECRI Institute on July 2, 2015. The information was verified by the measure developer on July 13, 2015.

The information was reaffirmed by the measure developer on December 16, 2015.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

For more information, contact Debra Marchi at the American Academy of Ophthalmology (AAO), dmarchi@aao.org, regarding use and reproduction of these measures.

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