Characteristics of cataract surgery patients influencing patient satisfaction scores

Patient-Reported Outcomes With Wavefront-Guided Laser in Situ Keratomileusis (PROWL) Study Outcomes From a Single Institution

PURPOSE

To determine patient-reported outcomes after laser in situ keratomileusis (LASIK) using wavefront-guided technology at a single institution.

METHODS

In this prospective observational study, 62 participants underwent examination and questionnaire at baseline, 1 month, and 3 months after surgery. The questionnaire included questions from validated questionnaires and new items to assess patient satisfaction with current vision and LASIK surgery, and existence/degree of visual symptoms.

RESULTS

At month 1, patients reported an improvement in far vision (P = .01), activity limitations (P ≤ .001), and less worry about vision (P ≤ .001), as well as new visual symptoms, including halos (P ≤ .001) and double images (P = .03). At month 3, patients still noted an improvement in near vision (P = .05), far vision (P ≤ .001), activity limitation (P ≤ .001), and worry (P ≤ .001) along with halos (P = .05), double images (P = .01), and dry eye (P = .01). A total of 3.3% of patients at month 1 and 0% at month 3 had difficulty performing any activity due to symptoms, and 34.6% and 25.0% of patients reported decreased quality of life at months 1 and 3, respectively.

CONCLUSIONS

After LASIK, patients experience new visual symptoms. Patients have high rates of satisfaction overall but with some patients reporting a decrease in quality of life 1 month after surgery; quality of life improves by postoperative month 3, with 25% patients reporting a decrease in visual well-being after surgery. [J Refract Surg. 2023;39(3):198-204.].

Patient Experience and Satisfaction With Immediate Sequential and Delayed Sequential Bilateral Cataract Surgery

PURPOSE

In bilaterally pseudophakic patients who received immediate or delayed sequential bilateral cataract surgery (ISBCS or DSBCS), we sought to determine patient experience, particularly related to the loss of opportunity to modify the surgical plan for the second eye.

DESIGN

Cross-sectional.

METHODS

Patients who received ISBCS (n = 1818) and DSBCS (n = 1818) in the Kaiser Permanente Northern California system between 2017 and 2019 who actively used the electronic patient portal were randomly selected and sent a survey link. The survey inquired about reasons for choosing ISBCS or DSBCS, concerns about surgery, and whether the loss of opportunity to modify the surgical plan for the second eye affected the patient's decision to undergo ISBCS.

RESULTS

Participation was 18% among patients who received ISBCS and 17% among patients who received DSBCS. Of the patients who received ISBCS, 96% would choose ISBCS again while 80% of patients who received DSBCS would choose DSBCS again (P < .0001). Convenience was the leading reason patients chose ISBCS (65%), whereas surgeon recommendation was the primary reason patients chose DSBCS (68%). Sixteen percent of patients who received ISBCS and 38% of patients who received DSCBS reported that the possibility of modifying the surgical plan to reduce the need for corrective lenses in the second eye was an important consideration (P < .0001).

CONCLUSIONS

Compared with patient who chose DSBCS, patients who chose ISBCS were more likely to choose ISBCS again and to recommend ISBCS to a family member or friend. The option to modify the surgical plan for the second eye to reduce need for glasses or contact lenses was not an important consideration for most of either group.

A One-Week Course of Levofloxacin/Dexamethasone Eye Drops: A Review on a New Approach in Managing Patients After Cataract Surgery

A new fixed-dose combination of dexamethasone and levofloxacin eye drops has recently been approved for the prevention and treatment of inflammation, and the prevention of infection associated with cataract surgery in adults. This combination has been developed to respond to a series of unmet needs in the practical management of patients undergoing cataract surgery. Namely, despite updated guidelines, many ophthalmologists employ protocols mainly based on their personal experience. As a result, the choice of drugs, treatment duration, and drug association is not evidence-based medicine (EBM)-oriented. In addition, antibiotic resistance may occur since antibiotics are used for an extended length of time, even with tapering. Corticosteroids are also prescribed for prolonged periods, frequently without follow-up. Therefore, patient adherence to postsurgical self-care is low, and mainly affects older patients who are the majority undergoing cataract surgery. In both rabbit and human trials, it has been demonstrated that both active ingredients penetrate the ocular system without pharmacokinetic interaction between the two. The concentrations of both ingredients in aqueous humor after their ocular instillation are high enough at the site of action to carry out their expected potent anti-inflammatory and antibiotic activity. Tested in a pivotal study aimed at investigating efficacy and safety of the intended indication, the mixture/compound was non-inferior to a 2-week treatment with dexamethasone/tobramycin in preventing or reducing inflammation and in preventing infection when administered for 1 week, followed by the administration of dexamethasone alone for another week. The outcomes obtained by this study suggest that a 1-week course of levofloxacin/dexamethasone eye drops is sufficient to resolve inflammation and prevent infection in patients undergoing cataract surgery. In addition, this study underlines that a follow-up visit after 1 week allows for a decision about whether to stop or continue a treatment in patients still experiencing symptoms or inflammation. In conclusion, this new dose combination could represent a turning point in managing patients after cataract surgery, while mostly avoiding antibiotic resistance and improving treatment adherence.

Impact of Refractive Outcomes on Bias in Follow-up and Completion of Patient-Reported Outcome Measures after Laser Vision Correction

PURPOSE

To examine factors contributing to completion of a patient-reported outcome (PRO) measure in patients undergoing laser vision correction.

DESIGN

Retrospective, population-based study.

PARTICIPANTS

All patients who underwent primary laser vision correction with a target of plano from July 1, 2014, to June 30, 2016, at a large refractive surgery center.

METHODS

Patients were asked to complete a PRO measure at the time of their preoperative and months 1 and 3 postoperative visits. Characteristics between patients who attended and did not attend the follow-up visits and completed and did not complete the PRO measure were compared. A logistic regression was performed to identify factors associated with likelihood of follow-up and completion of PRO measure. An inverse probability censoring weighted model was created to account for selective loss to follow-up and used to adjust the PRO satisfaction measure.

MAIN OUTCOME MEASURE

Completion of the PRO measure at 1 and 3 months.

RESULTS

A total of 37 043 patients were identified. Of these, 20 501 completed a 1-month postoperative PRO measure and 10 474 completed a 3-month postoperative PRO measure. Patients completing a PRO measure were more likely to be older, be female, have had photorefractive keratectomy (PRK), have completed a preoperative PRO measure, and have had a preoperative hyperopic correction (P < 0.001 for all comparisons). For every line of postoperative uncorrected acuity worse than 20/16, the odds ratio of completing a PRO measure was 1.33 (95% confidence interval [CI], 1.30-1.36, P < 0.001) at 1 month and 1.29 (95% CI, 1.26-1.33, P < 0.001) at 3 months. At 1 month, there was no difference between the raw and model-adjusted rates of satisfaction with vision, but at 3 months the adjusted rate was significantly higher than the raw rate.

CONCLUSIONS

Patients with worse objective visual outcomes were more likely to complete PRO measures in this population-based study. In a setting with loss to follow-up, PRO measures require methods to address missing data for correct interpretation.

Ultra-Widefield Fluorescein Angiography Findings in Patients with Macular Edema Following Cataract Surgery

Purpose: To evaluate the ultra-widefield fluorescein angiography (UWFA) findings in patients with macular edema (ME) following cataract surgery.Methods: Thirty-three eyes from patients who showed greater than a 30% increase in the central subfield thickness following cataract surgery were included. UWFA scored according to a system suggested by the Angiography Scoring for Uveitis Working Group (ASUWG). Factors associated with a high ASUWG score were evaluated.Results: Thirty-three (100.0%) of the 33 eyes showed abnormal UWFA findings, including optic disc staining (81.8%), capillary leakage (100.0%), pinpoint leakage (84.8%), peripheral retinal vascular leakage (24.2%) and retinal staining (6.1%). Multiple regression analysis reveals that following adjustment for other factors, younger age was independently associated with a higher ASUWG score (R² = 0.476, p = .001).Conclusions: Patients with ME following cataract surgery show generalized inner and outer blood-retinal barrier breakage. Particular attention is required during cataract surgery in young patients.