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November 12, 1997

Cataract Extraction Rates and Insurance Status-Reply

Author Affiliations

Lenox Hill Hospital New York, NY

JAMA. 1997;278(18):1491. doi:10.1001/jama.1997.03550180041025

In Reply.  —Dr Kliger's letter raises several valid points that might influence the behaviors of practitioners working in prepaid or FFS settings. The processes involved in clinical decision making in all fields of medicine are guided by the knowledge, skill, and experience of the physician or surgeon. Yet, despite the proficiency of the practitioner, he or she needs to base clinical decisions on current thinking in a particular area of interest. The American Academy of Ophthalmology's Preferred Practice Patterns (PPPs)1 were initially introduced in the late 1980s and have undergone review approximately every 3 years. These are evidence-based documents that rely on consensus opinion of a group of experts when evidence is lacking on a particular point.The PPP "Cataract in the Adult Eye"1 was written by a group that was composed of ophthalmologists, an internist, a methodologist, and a patient representative. The document is intended to serve as a