Functional, psychological, and satisfaction outcomes of laser in situ keratomileusis for high myopia

BCLA CLEAR Presbyopia: Management with corneal techniques

Corneal techniques for enhancing near and intermediate vision to correct presbyopia include surgical and contact lens treatment modalities. Broad approaches used independently or in combination include correcting one eye for distant and the other for near or intermediate vision, (termed monovision or mini-monovision depending on the degree of anisometropia) and/or extending the eye's depth of focus [1]. This report reviews the evidence for the treatment profile, safety, and efficacy of the current range of corneal techniques for managing presbyopia. The visual needs and expectations of the patient, their ocular characteristics, and prior history of surgery are critical considerations for patient selection and preoperative evaluation. Contraindications to refractive surgery include unstable refraction, corneal abnormalities, inadequate corneal thickness for the proposed ablation depth, ocular and systemic co-morbidities, uncontrolled mental health issues and unrealistic patient expectations. Laser refractive options for monovision include surface/stromal ablation techniques and keratorefractive lenticule extraction. Alteration of spherical aberration and multifocal ablation profiles are the primary means for increasing ocular depth of focus, using surface and non-surface laser refractive techniques. Corneal inlays use either small aperture optics to increase depth of field or modify the anterior corneal curvature to induce corneal multifocality. In presbyopia correction by conductive keratoplasty, radiofrequency energy is applied to the mid-peripheral corneal stroma, leading to mid-peripheral corneal shrinkage and central corneal steepening. Hyperopic orthokeratology lens fitting can induce spherical aberration and correct some level of presbyopia. Postoperative management, and consideration of potential complications, varies according to technique applied and the time to restore corneal stability, but a minimum of 3 months of follow-up is recommended after corneal refractive procedures. Ongoing follow-up is important in orthokeratology and longer-term follow-up may be required in the event of late complications following corneal inlay surgery.

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.].

Reversal of Myopic Correction for Patients Intolerant to LASIK

Purpose

To evaluate the outcome of the reversal of myopia correction in patients intolerant to LASIK.

Methods

This study is a retrospective and case series of patients who decided to reverse their previous myopic LASIK correction between July 2012 and July 2020. It was conducted at a private refractive surgery centre, Ismailia, Egypt. The patients were followed up after reversal treatment for one year. Primary LASIK and reversal treatment were performed by a 500 kHz Amaris excimer laser platform. The main outcomes included refractive predictability, stability, efficacy, and safety and any reported complications.

Results

This study included 48 eyes of 24 patients (6 male and 18 female patients). The average duration between the primary LASIK surgery and reversal treatment was 3.20 ± 0.30 months (range 3 to 4 months). Reversal treatment was bilateral in all patients. The mean age of the patients was 38 ± 1.9 years (range 37 to 45 yrs). After reversal, the mean postreversal cycloplegic refraction spherical equivalent was −1.82 ± 0.34 D (range −1.50 to −3.00 D). The mean ablation depth was 34.10 ± 7.36 μm (range 20 to 46 μm), and the mean of the central corneal thickness 12 months after reversal treatment was 510.2 ± 14.4 μm (range 515 to 487 μm). The mean keratometric reading was 42.6 ± 1.6 (range 42.5 to 44.8). The mean of CDVA was 0.2 ± 0.03 log MAR (range −0.10 to 0.4 log MAR). The mean optical zone of reversal treatment was 6.1 ± 0.3 mm (range 5.9 to 6.2 mm). UDVA was 0.4 log MAR in 87.5% of the patients, 0.5 log MAR in 8.3% of the patients, and 0.6 log MAR in 4.2% of the patients. CDVA remained unchanged in 83.3% of patients; 2.1% of the patients gained one line of CDVA (Snellen); 8.3% of the patients lost one line of CDVA; 6.3% of the patients lost two lines of CDVA. No cases of corneal ectasia were recorded. The only postoperative complications were flap microfolds in 3 eyes (6.25%).

Conclusion

In conclusion, this study demonstrates that reversal of myopic LASIK treatment is a safe, stable, and effective option for intolerant patients.

Pharmacological Myopia Control Influence on Quality of Life and Psyche among Adolescents

Myopia is a global problem affecting all aspects of patients’ lives. Objectives: The aim of the study was to evaluate the influence of low dose atropine (LDA) myopia control on the quality of life in patients with myopia. Material and Methods: A self-constructed questionnaire, including eight questions, was distributed among 40 patients. The questionnaire was divided into two subsections: (1) influence of LDA on visual functions and (2) influence of LDA on self-esteem. Answers were collected separately for boys (18 patients) and girls (22 patients) and compared considering spherical equivalent (SE) and myopia progression rate. Results: Girls reported more issues with near activities and pupil size. Boys and girls complained similarly, regarding the sun glare. We found a high level of certainty about the efficacy of LDA therapy among both examined groups and a little improvement in self-esteem. Girls recommended LDA therapy more often than boys, especially when the progression rate was low. There was no statistically significant difference in answer scores between groups with different myopia progression rates for boys. Girls with lower progression rates reported more issues with near work and sun glare and less trust in LDA therapy’s effectiveness than girls with a higher progression rate. There was no statistically significant correlation between SE and the total answer score for both genders. Conclusions: Findings concerning childrens’ and adolescents’ psyche are a new aspect of myopia control. We prove that patients during pharmacological myopia control did not report significant problems caused by LDA therapy and they were convinced about its efficacy, had greater self-esteem, and recommended it to peers.

Subjective Happiness and Satisfaction in Postoperative Anisometropic Patients after Refractive Surgery for Myopia

Laser-assisted in situ keratomileusis (LASIK) contributes to increased patient happiness one month after surgery; however, longer term effects are unknown. We performed a retrospective cross-sectional study on 472 patients who underwent bilateral LASIK surgery to measure happiness and satisfaction with LASIK, and to identify affecting factors. Patients completed questionnaires on satisfaction with the surgery and the subjective happiness scale (SHS) before, and 1, 3, 6, and 12 months after surgery. Multiple regression analyses were performed to determine independent predictors of SHS and satisfaction scores. Mean SHS increased at one month but was similar to baseline levels by six months. The SHS of older patients was greater than younger ones at baseline and at one and three months, while satisfaction among the older group was poorer at one and three months. Multiple regression analyses revealed that the decrease in SHS score from one month to three months correlated with baseline SHS, SHS at one month, uncorrected distance visual acuity (UDVA), and age. Regression analysis revealed SHS at six months correlated with preoperative SHS, SHS at one month, and satisfaction at six months. Satisfaction at final visit correlated with age, UDVA, anisometropia, and with SHS at each visit. We conclude that happiness and satisfaction were age- and UDVA-dependent, and anisometropic patients report poorer satisfaction scores.

Postoperative Functional and Cosmetic Satisfaction among Subjects Undergoing Open Versus Endonasal Septorhinoplasty: Five Years' Experience from an Open-label Study at a Tertiary Care Center in Oman

Objectives

We sought to compare functional and cosmetic satisfaction among male and female patients undergoing open and closed septorhinoplasty within sub-groups of indications for the surgery at a tertiary care hospital in Oman.

Methods

We conducted a prospective study in the ear, nose, and throat surgery department at Sultan Qaboos University Hospital from 2010 to 2015. All patients aged above 17 years, without dysmorphic pathologies, and due to be operated through open or endonasal septorhinoplasty based on the appropriate indications (functional or cosmetic or functional and cosmetic), were included in the study.

Results

Out of 215 patients who underwent septorhinoplasty, 30 were lost to follow-up. One-hundred and eighty-five patients (124 males and 61 females) available for postoperative assessment had been allocated to septorhinoplasty by the endonasal approach (n = 89; 59 males and 30 females) or open approach (n = 96; 65 males and 31 females) based on their indications for surgery: functional (n = 98; 64 males and 34 females); cosmetic (n = 39; 23 males and 16 females); and both functional and cosmetic (n = 48; 37 males and 11 females). Sex-wise distribution across different age groups for the specific surgical technique based on indication for surgery did not show any significant differences within any of the respective sub-groups. Both sexes reported no significant difference in satisfaction per their scores on the functional satisfaction scale post open or endonasal intervention. However, in their cosmetic satisfaction scale scores, a significantly higher proportion of males within the functional indication for surgery subgroup (90.9%) expressed satisfaction with the open surgical approach than the 71.0% males operated by the endonasal approach (p = 0.041).

Conclusions

Males undergoing septorhinoplasty for functional indications expressed significant satisfaction with the open surgical approach compared with the endonasal approach on the cosmetic satisfaction scale. This study could accrue only 185 patients during the five-year study period and hence was unable to generate any significant evidence to prove any differences in postoperative functional and cosmetic satisfaction outcomes within sub-groups based on other indications for surgery for males and females separately.

Laser Vision Correction for Regular Myopia and Supracor Presbyopia: A Comparison Study

A study to compare femto-presbyLASIK to standard myopia femto-LASIK refractive surgical correction with a total of 45 candidates was performed. The goal was to identify a more specific set of indications for presbyopia LASIK treatments. The results showed thoroughly good uncorrected visual acuity for myopia (decimal: 1.01 ± 0.15) as well as for presbyLASIK (decimal: 0.78 ± 0.17) corrections. Astigmatism was comparable in both groups and did not change significantly from preoperative (0.98D ± 0.53 SD) to postoperative (1.01D ± 0.50 SD). Our study results suggest, that presbyLASIK treatment is as safe and effective as regular LASIK myopia correction and can hence be recommended to treat presbyopia.

Comparing Patient-Reported Outcomes of Laser In Situ Keratomileusis and Small-Incision Lenticule Extraction: A Review

PURPOSE

Laser in situ keratomileusis (LASIK) and small-incision lenticule extraction (SMILE) are popular refractive surgeries. The objective refractive outcomes of LASIK and SMILE have been studied extensively; both procedures have comparable safety, efficacy, and predictability. However, owing to various psychosocial factors, refractive patients may report dissatisfaction despite good postoperative vision. Hence the importance of studies on subjective patient-reported outcomes. This review discusses the role of psychometric-technique-based validated questionnaires when evaluating subjective outcomes. It also summarizes the literature on patient-reported outcomes for LASIK and SMILE.

DESIGN

A literature search was performed on PubMed database to identify studies that have assessed patient-reported outcomes for LASIK and SMILE.

RESULTS

Several studies have looked into patient-reported outcome measures for LASIK, but the number of equivalent studies for SMILE is limited. Questionnaires (validated and non-validated) are used to evaluate patient-reported outcomes. Validated questionnaires are designed based on psychometric techniques, such as Classic Test Theory, Item Response Theory, and Rasch analysis. The Quality of Life Impact of Refractive Correction (QIRC) questionnaire, a validated questionnaire administered to both LASIK and SMILE patients, suggests that both groups have comparable vision-related quality of life in the first few months postoperatively; but SMILE might confer a slight advantage in the later postoperative period (postoperative month 6).

CONCLUSIONS

Future LASIK-SMILE comparative studies utilizing standardized validated questionnaires for patient-reported outcome measures with longer follow-up durations would be a welcome contribution to this important aspect of refractive surgery.

The Implantable Collamer Lens with a central port: review of the literature

The purpose of this review is to summarize preclinical and clinical data from publications appearing in the peer-reviewed scientific literature relevant to the safety and effectiveness of the EVO Implantable Collamer Lens (ICL) posterior chamber phakic refractive lens with a central port (V4c Visian ICL with KS Aquaport, STAAR Surgical, Inc.). A literature search was conducted using PubMed.gov to identify all articles relating to the EVO ICL. Articles were examined for their relevance, and the references cited in each article were also searched for additional relevant publications. On the basis of a total of 67 preclinical studies and clinical reports, including effectiveness data on 1,905 eyes with average weighted follow-up of 12.5 months and safety data on 4,196 eyes with weighted average follow up of 14.0 months, the EVO ICL is safe and effective for the correction of a broad range of refractive errors. High levels of postoperative uncorrected visual acuity, refractive predictability, and stability demonstrate the effectiveness of the EVO ICL. Safety data suggest reduced rates of anterior subcapsular cataract and pupillary block compared with earlier models. Improved safety and proven effectiveness make EVO an attractive option for surgeons and patients.

Prospective Randomized Multicenter Comparison of the Clinical Outcomes of V4c and V5 Implantable Collamer Lenses: A Contralateral Eye Study

Purpose

To compare the visual and refractive outcomes and night vision performance questionnaire results between V4c and V5 implantable Collamer lenses in a prospective, randomized, multicenter study.

Settings

Four refractive surgery centers.

Design

Prospective randomized multicenter single-masked comparative study.

Methods

Twenty-three patients were enrolled in this study. A conventional V4c model (EVO Visian ICL) was implanted in one eye, and a V5 model (EVO+ Visian ICL), which has a larger optic diameter than the V4c model, was implanted in the contralateral eye. The uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were evaluated before and 6 months after surgery. At 6 months after surgery, a questionnaire on night vision disturbances was administered. The efficacy, safety, and predictability of the two implanted ICL models were compared.

Results

There were no significant differences in the postoperative UDVA and CDVA between the two ICL models. The mean efficacy indexes for the V4c and V5 lenses were 1.16 ± 0.22 and 1.03 ± 0.23, respectively. The mean safety indexes of the V4c and V5 lenses were 1.21 ± 0.20 and 1.19 ± 0.20, respectively. The night vision performance questionnaire revealed that 7 patients (37%) noticed a difference in visual performance between the eyes, and all of them reported that they could see better at night with the V5-implanted eye compared with the V4c-implanted eye.

Conclusion

The V4c and V5 ICL models achieved similar visual and refractive outcomes, whereas the V5 model showed a possible advantage in reducing night vision disturbances.

Predictive Factors for Successful High Myopia Treatment Using High-Frequency Laser-In-Situ Keratomileusis

Aim

To evaluate the predictive factors of LASIK procedure for high myopia with or without astigmatism using a combination of high-frequency femtosecond-assisted LASIK followed by an excimer laser.

Methods

This study was a retrospective interventional case series study to evaluate myopic eyes undergoing high platform LASIK with FEMTO LDV Z2 intervention, followed by WaveLight®EX500 excimer laser machine. Subjects were divided into 2 groups: high myopia (SE of -6.01 to -9.00 D) and very high myopia (SE of -9.01 D or higher). Myopic eyes (Spherical Equivalent/SE) less than -13 D were included in this study. Visual Acuity (VA) was evaluated 1 day and 60 days after the procedure. Predictive factors, such as age, degree of sphere, degree of astigmatism, keratometric reading and axial length were analyzed to detect any influences affecting the final VA results.

Results

A total of 316 myopia eyes underwent intervention, mean age: 25.3±3.8 years. Target treatment was achieved in 96.1% of patients with high myopia and 69.9% of patients with very high myopia. High degree of sphere and astigmatism constitutes an important factor influencing final VA.

Conclusion

Modern machines provide a more promising efficacy and success of LASIK procedure in high myopia: important predictive factors were a high degree of sphere and astigmatism for achieving the optimal final outcome.

Effect of Varying Levels of Glare on Contrast Sensitivity Measurements of Young Healthy Individuals Under Photopic and Mesopic Vision

Contrast sensitivity (CS), the ability to detect small spatial changes of luminance, is a fundamental aspect of vision. However, while visual acuity is commonly measured in eye clinics, CS is often not assessed. At issue is that tests of CS are not highly standardized in the field and that, in many cases, optotypes used are not sensitive enough to measure graduations of performance and visual abilities within the normal range. Here, in order to develop more sensitive measures of CS, we examined how CS is affected by different combinations of glare and ambient lighting in young healthy participants. We found that low levels of glare have a relatively small impact on vision under both photopic and mesopic conditions, while higher levels had significantly greater consequences on CS under mesopic conditions. Importantly, we found that the amount of glare induced by a standard built-in system (69 lux) was insufficient to induce CS reduction, but increasing to 125 lux with a custom system did cause a significant reduction and shift of CS in healthy individuals. This research provides important data that can help guide the use of CS measures that yield more sensitivity to characterize visual processing abilities in a variety of populations with ecological validity for non-ideal viewing conditions such as night time driving.

Effects of V4c-ICL Implantation on Myopic Patients' Vision-Related Daily Activities

The new type implantable Collamer lens with a central hole (V4c-ICL) is widely used to treat myopia. However, halos occur in some patients after surgery. The aim is to evaluate the effect of V4c-ICL implantation on vision-related daily activities. This retrospective study included 42 patients. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), endothelial cell density (ECD), and vault were recorded and vision-related daily activities were evaluated at 3 months after operation. The average spherical equivalent was −0.12 ± 0.33 D at 3 months after operation. UCVA equal to or better than preoperative BCVA occurred in 98% of eyes. The average BCVA at 3 months after operation was −0.03 ± 0.07 LogMAR, which was significantly better than preoperative BCVA (0.08 ± 0.10 LogMAR) (P = 0.029). Apart from one patient (2.4%) who had difficulty reading computer screens, all patients had satisfactory or very satisfactory results. During the early postoperation, halos occurred in 23 patients (54.8%). However there were no significant differences in the scores of visual functions between patients with and without halos (P > 0.05). Patients were very satisfied with their vision-related daily activities at 3 months after operation. The central hole of V4c-ICL does not affect patients' vision-related daily activities.

Corneal Aberrations, Contrast Sensitivity, and Light Distortion in Orthokeratology Patients: 1-Year Results

Purpose. To evaluate the corneal higher-order aberrations (HOA), contrast sensitivity function (CSF), and light distortion (LD) in patients undergoing orthokeratology (OK). Methods. Twenty healthy subjects (mean age: 21.40 ± 8 years) with mean spherical equivalent refractive error M = −2.19 ± 0.97 D were evaluated at 1 day, 1 month, and 1 year after starting OK treatment. Monocular LD, photopic monocular CSF, and corneal HOA for 6 mm pupil size were measured. Results. LD showed an increase after the first night (p < 0.05) and recovery to baseline after 1 month, remaining stable after 1 year (p > 0.05). Spherical-like, coma-like, and secondary astigmatism HOA RMS increased significantly (p ≤ 0.022) from baseline to 1-month visit, remaining unchanged over the follow-up. Contrast sensitivity for medium frequencies (3.0, 4.24, and 6.00 cpd) was significantly correlated with LD parameters at baseline (r ≤ −0.529, p < 0.001). However, after 1 year of treatment, this correlation was only statistically significant for 12 cpd spatial frequency (r ≤ −0.565, p < 0.001). Spherical-like RMS for 6 mm pupil size correlated with irregularity of the LD (r = −0.420, p < 0.05) at the 1-year visit. Conclusion. LD experienced by OK patients recovers after one month of treatment and remains stable in the long term while optical aberrations remain significantly higher than baseline.

Four-year follow-up of corneal aberrations and visual functions of myopic patients after laser in situ keratomileusis

Objective:

To report on 4-year follow-up of corneal higher-order aberrations and daily visual functions of myopic patients after laser in situ keratomileusis (LASIK).

Methods:

One hundred thirty four eyes of 67 patients who underwent LASIK guided by aspherical ablation were included in this study. The vision, corneal spherical aberration (SphA) and Coma were recorded before LASIK and at 6 month and 4 year after LASIK. The evaluation of the questionnaire about daily visual functions was performed by the same physician after LASIK.

Results:

No eye decreased the BCVA during 4 year follow-up. The effect index and safety index were 1.08±0.16, 1.11±0.17 and 1.12±0.16, 1.13±0.14 respectively at 6 month and 4 year post-LASIK. After LASIK the corneal SphA and Coma were significantly increased, however the difference between 6 month and 4 year post-LASIK was no statistical significance. Most patients (94.3%-92.4%) felt satisfaction or high satisfaction about the ability to perform each daily visual function after LASIK. Meanwhile there was still about 7.4%-9.2% patients who complained that they could not drive at night. Further analysis showed that the score of driving at night was negative correlation with corneal SphA (r=-0.645, p=0.040; r=-0.688, p=0.040 at 6 month and 4 year post-LASIK respectively).

Conclusions:

Our four-year follow-up outcomes indicated that the myopic patients after LASIK had the long-term stable corneal aberration and satisfaction of daily visual functions.

Comparison of quality of life between myopic patients with spectacles and contact lenses, and patients who have undergone refractive surgery

Purpose

The present study aims at investigating and comparing the vision-related quality of life of myopic persons who wear spectacles or contact lenses with those who have undergone refractive surgery. It also compares the vision-related quality of life of these two groups with that of emmetropes.

Method

In this study, the questionnaire of evaluation instrument of refractive error in quality of life (NEI/RQL-42) was used to compare the quality of life between 154 myopic patients with spectacles and contact lenses, and 32 patients who have undergone refractive surgery. The two groups were also compared with 54 emmetropes. The questionnaire included 13 different subgroups (score 0–100) related to vision. Data was analyzed using SPSS software.

Results

The overall score of quality of life in emmetropes (95.11 ± 4.23) was more than that in persons who had undergone refractive surgery (86.98 ± 4.73), and it was the least in the group wearing spectacles or contact lenses (78.30 ± 9.21), (P < 0/001). Furthermore, except for a glare variable, the studied groups indicated a statistically significant difference in all the thirteen subgroups of vision-related quality of life.

Conclusion

Quality of life for people with myopia who had the refractive surgery was better than people with myopia who wore spectacles or contact lenses. Although quality of life in people with myopia who had the refractive surgery was less than emmetropia, it seems that refractive surgery improves quality of life of myopic patients.

Mesopic Functional Visual Acuity in Normal Subjects

To evaluate mesopic functional visual acuity (FVA) with a newly developed system in normal subjects and to compare the results with photopic FVA, sixty-eight healthy volunteers (24.03 ± 4.42 [mean ± standard deviation] years) were enrolled in this study. A commercially available FVA measurement system (AS-28; Kowa, Aichi, Japan) was modified to measure FVA under mesopic conditions as well as photopic conditions. Measurements were performed monocularly in photopic conditions during 60 seconds. After dark adaptation for 15 minutes, the same measurements were repeated in mesopic conditions. Outcomes included starting visual acuity (VA), FVA (the average of VAs), visual maintenance ratio (VMR), maximum VA, minimum VA, and numbers of blinks during the 60-second measurement session, and were compared between mesopic and photopic conditions. Starting VA was –0.11 ± 0.08 and 0.39 ± 0.12 logarithm of the minimum angle of resolution (logMAR) in photopic and mesopic conditions, respectively. FVA was –0.06 ± 0.09 and 0.52 ± 0.14 logMAR, VMR was 0.98 ± 0.02 and 0.94 ± 0.04, maximum VA was –0.15 ± 0.06 and 0.33 ± 0.12 logMAR, the minimum VA was 0.05 ± 0.12 and 0.78 ± 0.20 logMAR, and the number of blinks was 8.23 ± 7.54 and 7.23 ± 6.20, respectively. All these parameters except the number of blinks were significantly different between the two conditions (P < 0.001). Besides, the difference between maximum and minimum VAs and standard deviation of VA were significantly larger in mesopic than in photopic conditions (P < 0.001). This study revealed that not only overall visual function decline but also instability of vision under mesopic conditions even in healthy subjects.

Screening of refractive surgery candidates for LASIK and PRK

PURPOSE

The aim of this study was to evaluate exclusion criteria in screening patients for refractive surgery.

METHODS

Patients screened for initial refractive surgery by a single surgeon at the Cole Eye Institute (Cleveland Clinic) between 2007 and 2012 were reviewed. Exclusion criteria for patients who were not offered refractive surgery based on history and/or examination parameters were analyzed.

RESULTS

A total of 1067 refractive candidates were enrolled in the study. Five hundred nineteen (48.6%) were male and 548 (51.4%) were female with a mean age of 39 ± 12 (range, 17-78) years. Refractive surgery was performed in 657 (61.6%) patients, and photorefractive keratectomy was considered the best option for 106 (9.9%) patients. Four hundred ten (38.4%) of all screened patients did not have refractive surgery, and 134 of these patients (12.6%) were considered to have contraindications for laser in situ keratomileusis and photorefractive keratectomy. Among the excluded patients, 69 (51.5%) were male and 65 (48.5%) were female with a mean age of 40 ± 14 (range, 18-78) years. Abnormal corneal topography (34.3%) and low or insufficient corneal thickness (23.1%) were the most common reasons for exclusion. High myopia (10.5%) and (insipient or definite) cataract (9.7%) were also common reasons for exclusion. Other common factors for exclusion were high hyperopia (3.7%), need to wear reading glasses after surgery (3.7%), and severe dry eye unresponsive to treatment (3.7%).

CONCLUSIONS

Abnormal corneal topography and low, or insufficient, corneal thickness remain the most common exclusion factors for corneal refractive surgery. Factors such as cataract, too high of correction, and severe dry eye are also common reasons for exclusion of patients.

Prospective randomized contralateral eye evaluation of subjective quality of vision after wavefront-guided or wavefront- optimized photorefractive keratectomy

PURPOSE

To compare the effect of wavefront-guided (WFG) and wavefront-optimized (WFO) photorefractive keratectomy (PRK) on patient perceived quality of vision.

METHODS

Seventy-one patients (142 eyes) were enrolled in this prospective, randomized, fellow eye controlled study. One eye was randomized to undergo WFG PRK treatment by the AMO Visx CustomVue S4 IR excimer laser system (Abbott Medical Optics, Inc., Santa Clara, CA) and the fellow eye received WFO PRK treatment by the Alcon Allegretto Wave Eye-Q 400 Hz excimer laser system (Alcon Laboratories, Inc., Fort Worth, TX). Patients answered questionnaires on their visual symptoms and quality of vision preoperatively and at 1, 3, 6, and 12 months after surgery.

RESULTS

Patients in both groups reported better vision compared to baseline from 3 months onward (mean change in score of 1.56 to 2.51 in the WFO group and 1.54 to 2.28 in the WFG group, P ⩽ .003). Both groups experienced less nighttime glare from 6 months onward (P ⩽ .030). Halos, double vision, and visual clarity were initially worse (P ⩽ .025) but not significantly different after 1 month. Haze and fluctuating vision resolved after 3 months. Visual symptoms were similar between the two groups at all times (P ⩾ .059) except at 6 months, when patients felt their WFG eyes had more excellent vision (P = .029). A composite of all symptoms was also similar between the groups until 12 months when patients had fewer symptoms in their WFO eye (P = .044).

CONCLUSIONS

One year after surgery, patient self-reported visual symptoms were not significantly different in eyes receiving WFG or WFO PRK. However, the average of all symptoms was lower in eyes receiving wavefront-optimized treatment.

Stability of axis and patient satisfaction after toric implantable collamer lens implantation for myopic astigmatism

Objectives: To assess the stability of axis and patient satisfaction after toric visian implantable collamer lens (TICL) implantation for moderate to high myopic astigmatism.

Methods: Total 33 eyes of 21 consecutive patients who underwent implantation of TICL for the correction of moderate to high myopic astigmatism were recorded and a minimum follow-up of six months was performed. The deviation of axis of TICL was detected from one week to six months postoperatively. The evaluation of the visual functions was done by the same clinician at six months after surgery.

Results: The mean refractive cylinder decreased from -2.48±0.91 diopters (D) preoperatively to -0.54±0.25D and -0.50±0.19D at one week and six months after surgery respectively. Mean changes in astigmatism from one week to six months after surgery was 0.03±0.17D. The mean deviation of axis of TICL from one week to six months postoperatively was 2.48±1.25°(range,1°~ 6°) and no TICL required secondary repositioning. 14.3% patients felt difficult about the middle distant visual function (Reading Computer Screen). Evaluations of other visual functions were positive or very positive.

Conclusions: Six months after implantation of the TICL, it showed slightly axis rotation and high satisfaction about the visual functions.

Patient and surgeon experience during laser in situ keratomileusis using 2 femtosecond laser systems

PURPOSE

To describe the subjective experience of patients and surgeons during laser in situ keratomileusis (LASIK) using the Intralase 60 kHz or the Visumax 500 kHz femtosecond laser.

SETTING

Singapore National Eye Centre, Singapore.

DESIGN

Prospective randomized clinical study.

METHODS

In myopic patients, LASIK was performed with the corneal flap created using the 60 kHz laser in 1 eye and the 500 kHz laser in the contralateral eye. Postoperatively, patients completed a standardized validated questionnaire about their subjective intraoperative experiences (eg, light perception, pain, fear). Surgeons reported their intraoperative experiences and preferences.

RESULTS

Loss of light perception occurred in 50.0% of 60 kHz laser cases and 0% of 500 kHz laser cases during docking and in 63.0% and 0% of cases, respectively, during laser flap creation (P < .0001). The mean pain score with the 60 kHz laser was significantly higher during docking (P < .0001) but not during laser flap cutting (P = .006). Subconjunctival hemorrhage occurred in 67.4% of eyes with the 60 kHz laser and in 2.2% of eyes with the 500 kHz laser (P < .0001). The 500 kHz laser was preferred by 78.3% of patients, while 21.7% preferred the 60 kHz laser (P < .0001). The surgeons preferred the 60 kHz laser in 50.0% of cases and the 500 kHz laser in 8.7% (P < .0001); 41.3% had no preference.

CONCLUSIONS

Patients preferred surgery with the 500 kHz laser with no loss of light perception, less pain, less fear, and less subconjunctival hemorrhage. Surgeons preferred the 60 kHz laser.

Risk factors associated with night vision disturbances after phakic intraocular lens implantation

PURPOSE

To investigate the incidence and severity of night vision disturbances after implantable collamer lens surgery and to analyze the risk factors.

DESIGN

Retrospective, noncomparative study.

METHODS

Medical charts from 50 eyes of 25 patients who underwent implantable collamer lens implantation were retrospectively reviewed. The incidence and severity of night vision disturbances were evaluated using questionnaires administered 6 months after surgery. Univariate simple and multiple logistic regression analyses were used to detect risk factors associated with postoperative night vision disturbances. Potential risk factors included in the analysis were keratometric value, anterior chamber depth, postoperative residual refractive error, higher-order aberrations, preoperative and postoperative mesopic pupil size, the difference between preoperative and postoperative mesopic pupil size, the difference between mesopic pupil size and implantable collamer lens optic zone diameter, white-to-white diameter, sulcus-to-sulcus diameter, and postoperative implantable collamer lens vaulting. The power, size, optic zone diameter, and toricity of the implantable collamer lens were also included as variables.

RESULTS

The incidence of night vision disturbances was 34.0% for halos and 26.0% for glare. Halos were found to be significantly related to the difference between mesopic pupil size and implantable collamer lens optic zone diameter (P = .013), white-to-white diameter of the cornea (P = .028), and implantable collamer lens optic zone diameter (P = .030). For glare, toricity of the implantable collamer lens was revealed as a significant risk factor (P = .047).

CONCLUSIONS

Although not severe, the incidence of night vision disturbances after implantable collamer lens implantation was not negligible. Possible risk factors for night vision disturbances include implantable collamer lens optic zone diameter, the difference between mesopic pupil size and implantable collamer lens optic zone diameter, and white-to-white diameter of the cornea for causing halos, and the toricity of the implantable collamer lens for causing glare.

Myopic LASIK in psychiatric patients

PURPOSE

To evaluate the surgical results obtained in patients with psychiatric disorders who underwent myopic laser in situ keratomileusis. (LASIK).

METHODS

Retrospective study of 156 eyes of 82 patients who underwent LASIK to correct a myopic spherical equivalent (SE) at Clínica Baviera-Instituto Oftalmológico Europeo, Bilbao, Spain. All procedures were performed with the Technolas Keracor 217 Z excimer laser. Patients had a preoperative diagnosis of bipolar disorder (79 eyes of 42 patients), schizophrenia (61 eyes of 32 patients), or obsessive-compulsive disorder (16 eyes of 8 patients). Before surgery, the average sphere of the series was -3.92 ± 2.24 D in the first group, -3.45 ± 2.03 D in the second group, and -3.39 ± 1.97 D in the third group. We surveyed the patients to analyze subjective assessment from the patient's perspective.

RESULTS

At the last available visit after treatment, we obtained an SE of ±0.50 D in 85.71% of eyes with bipolar disorder, 88.52% of eyes with schizophrenia, and 93.75% of eyes with obsessive-compulsive disorder. The efficacy index was 1.00 ± 0.20 in the first group, 1.03 ± 0.21 in the second group, and 1.00 ± 0.07 in the third group. No eye lost 2 lines or more of best spectacle-corrected visual acuity.

CONCLUSIONS

We found that patients with compensated psychiatric disorders, of which the surgeon was aware, achieved excellent results after surgery, with no remarkable complications. Patients tolerated the procedures well and were satisfied.

Visual and non-visual factors associated with patient satisfaction and quality of life in LASIK

PURPOSE

The aim of this study was to determine how laser in situ keratomileusis (LASIK) affects quality of life (QOL) and to identify factors that may affect satisfaction after LASIK.

METHODS

A total of 104 patients with a mean age of 29±6, treated with LASIK for myopia and astigmatism, were enrolled in a prospective study. High (90%) and low (10%) contrast visual acuity (CVA) were measured under photopic and scotopic conditions before surgery and at 3 months later. A multidimensional QOL scale (Institute for Eye Research multidimensional QOL scale), which assesses psychological characteristics, personality traits, cosmesis, frequency, and tolerance to disturbing visual and ocular symptoms, and overall satisfaction with vision correction, was also used. Paired rank tests were used to compare preoperative and postoperative vision and QOL scores. Correlations and a multiple linear regression were used to describe the relationship between CVA, QOL, and satisfaction after LASIK.

RESULTS

Significant postoperative changes included increased satisfaction following LASIK (P<0.001), reduced frequency of visual and ocular symptoms (P<0.001), and change in psychological characteristics (P=0.033). The change in satisfaction with LASIK can be predicted by a combination of preoperative satisfaction, postoperative frequency of disturbing visual and ocular symptoms, postoperative mean spherical equivalent, and postoperative scotopic high CVA (R (2)=0.725, P<0.05).

CONCLUSIONS

Satisfaction with LASIK is related to visual function, preoperative expectations, psychological characteristics, and uncorrected CVA achieved. An increased sense of subjective well-being, adaptability, and self-efficacy was evident after LASIK. Patients reported a more optimistic attitude to life and increase perceived QOL after surgery.

The Refractive Status and Vision Profile (RSVP): Translation Into Persian, Reliability and Validity

PURPOSE

To translate and test the reliability and validity of a Persian translation of the Refractive Status and Vision Profile (RSVP), a vision-related quality of life questionnaire, in Iran.

METHODS

Forward & backward translation, committee review and pilot testing were performed to develop a final Iranian version of the RSVP. Seventy-three consecutive patients with refractive error before or after refractive surgery at the LASIK ward of Farabi Eye Hospital completed the questionnaire. A convenience sample of 14 patients completed the questionnaire twice within one week. Reliability was measured by internal consistency (Cronbach's alpha) and the intraclass correlation coefficient for test-retest reliability. Validity was evaluated by correlation between the different RSVP subscales, known groups comparison analysis, and correlation between the subscales versus global items and traditional clinical measures.

RESULTS

Internal consistency was high (Cronbach's alpha : 0.71-0.92; except for the subscale expectations, alpha : 0.6). Test-retest reliability of subscales and the overall RSVP scale, as estimated by the intraclass correlation coefficient, was high except for optical problems and glare. Comparisons between pre- and post-operative groups of patients showed significantly higher (worse) scores for concern, physical/social functioning, and the overall score in the pre-operative group. Almost all subscales showed desirable inter-scale correlations.

CONCLUSION

The Iranian version of the RSVP is a reliable and valid measure of vision-related quality of life in patients with refractive error.

Pre-operative Quality of Life and psychological factors that influence patient decision making in LASIK

PURPOSE

To assess pre-operative visual function, psychological factors, personality traits and satisfaction in myopic patients seeking laser-assisted in situ keratomileusis (LASIK).

METHODS

Eligible patients seeking LASIK (n=183) and successful contact lens wearers (n=23) not interested in LASIK completed the Institute for Eye Research Quality of Life (QOL) Scale. Of the 183 patients seeking LASIK who completed the QOL instrument before LASIK, 30 declined the procedure and 153 underwent LASIK. One hundred and two patients who underwent LASIK attended their 3-month post-operative follow-up appointment and 51 patients failed to present for their post-operative follow-up appointment. Multiple comparisons (One-way Analysis of Variance (ANOVA)) were conducted to determine differences in visual function, psychological factors, personality traits and satisfaction between patient groups.

RESULTS

Successful soft contact lens (SCL) wearers reported better functional vision (P=0.001), felt more attractive (P=0.007), had a lower frequency of disturbing visual and ocular symptoms (P=0.027) and higher overall satisfaction with their current optical correction (P<0.001) than patients seeking LASIK. LASIK patients lost to follow-up showed higher self-efficacy, adaptability and well-being than the patients who completed their appointments and those who declined surgery (P<0.05).

CONCLUSIONS

Psychological characteristics, the perception of visual and ocular symptoms and satisfaction with the current method of optical correction play an important role in the decision to undergo LASIK. The IER QOL Scale is a valid and reliable instrument able to discriminate between different groups seeking choices for myopic correction. Psychological factors may influence the level of satisfaction with LASIK.

LASIK world literature review: quality of life and patient satisfaction

PURPOSE

To analyze the patient reported outcome of satisfaction after LASIK surgery.

DESIGN

Systematic review.

PARTICIPANTS

Patient data from previously reported studies.

METHODS

A literature search conducted for the years 1988 to 2008 that included pertinent LASIK surgery information from the review of 2915 retrieved citations. All abstracts from these citations were reviewed and 1581 were deemed to be relevant for review. Complete copies of each of these relevant (1581) articles were obtained, and after thorough analysis each was rated based on the strength of the study design and weight of evidence. A level I rating was assigned to properly conducted, well-designed, randomized clinical trials; a level II rating to well-designed cohort and case-control studies; and a level III rating to case series, case reports, and poorly designed prospective and retrospective studies. Level I and II rated, peer-reviewed articles were entered into a database, and level III articles were eliminated. A total of 309 articles were incorporated into this database, representing level I and level II well-controlled studies of primary LASIK surgery.

MAIN OUTCOME MEASURES

Patients' satisfaction rates and factors associated with dissatisfaction.

RESULTS

Nineteen of the 309 database articles (6.1%) reported on both patient quality of life and satisfaction and together encompassed a total of 2198 subjects. The procedures from these 19 articles took place between 1995 and 2003. The overall patient satisfaction rate after primary LASIK surgery was 95.4% (2097 of 2198 subjects; range of patient satisfaction for the 19 articles was 87.2%-100%). The patient satisfaction rate after myopic LASIK was 95.3% (1811 of 1901 patients), and after hyperopic LASIK was 96.3% (286 of 297 subjects).

CONCLUSIONS

Based on this review, worldwide, an average 95.4% of patients were satisfied with their outcome after LASIK surgery. With 16.3 million procedures performed worldwide, and more than a decade of clinical studies and technological innovation, LASIK surgery should be considered among the most successful elective procedures. LASIK surgery compares more favorably with other elective surgical procedures in terms of generally higher satisfaction rates.

Patient satisfaction and visual symptoms after wavefront-guided and wavefront-optimized LASIK with the WaveLight platform

PURPOSE

To investigate patient satisfaction and visual symptoms after wavefront-guided LASIK.

METHODS

A prospective, randomized, double-masked, controlled study comprised 200 eyes of 100 young patients who underwent LASIK for myopia and astigmatism. Patients were randomly divided into two different treatment groups: standard ablation using wavefront-optimized profiles (wavefront-optimized group) and aberration customized aspheric treatment ablation (customized group) using the WaveLight ALLEGRETTO platform. Patients were asked to complete questionnaires regarding reasons for surgery, satisfaction, and visual symptoms. Patients were followed for 6 months.

RESULTS

The most frequent motivating factor for surgery was to improve uncorrected visual acuity (UCVA) in the wavefront-optimized and customized groups (both 100%), followed by freedom from spectacles (86.9% vs 96.3%). At 6 months postoperatively, over 95% of patients in both groups reported their UCVA was as good as anticipated and they were satisfied with the surgery and would recommend the operation to a friend or family member. Satisfaction was not correlated with age, attempted refractive error, residual refractive error, postoperative UCVA, or root-mean-square higher order aberration. The rate of postoperative overall visual symptoms was reduced and the mean analog scores of the symptoms in both groups did not change significantly postoperatively (P > .05). The rate of visual symptoms such as glare (8.7% vs 7.4%), halo (0% vs 7.4%), and night driving difficulty (8.7% vs 3.7%) decreased after LASIK at 6 months postoperatively in the wavefront-optimized and customized groups, respectively.

CONCLUSIONS

Patient satisfaction was achieved in young myopic patients who underwent wavefront-guided and standard ("wavefront-optimized") LASIK. The rate of visual symptoms such as glare, halo, and night driving difficulty decreased postoperatively after both treatment protocols.

Mesopic contrast sensitivity and ocular higher-order aberrations after overnight orthokeratology

PURPOSE

To investigate mesopic contrast sensitivity and night driving ability in eyes undergoing overnight orthokeratology, and to analyze the relationship among mesopic contrast sensitivity, ocular higher-order aberrations, and myopic correction.

DESIGN

Prospective, noncomparative, consecutive case series.

METHODS

In 44 eyes of 22 subjects (mean age +/- standard deviation [SD], 24.0 +/- 3.2 years) with orthokeratology, ocular aberrations and mesopic contrast sensitivity were determined before and three months after commencement of the procedure. Mean spherical equivalent refraction +/- SD was -2.34 +/- 0.99 diopters at baseline. Mesopic contrast sensitivity with and without glare was assessed using the Mesotest II (Oculus, Wetzlar, Germany).

RESULTS

Orthokeratology significantly reduced the log mesopic contrast sensitivity from 0.25 +/- 0.08 to 0.08 +/- 0.10 without glare (P < .0001, Wilcoxon) and from 0.21 +/- 0.11 to 0.07 +/- 0.10 with glare (P < .0001). The proportion of eyes that fulfilled the German standard recommendation level for night driving was 36%. The induced changes in log mesopic contrast sensitivity showed significant negative correlation with the changes in third-order (r = -0.490, P = .0013 without glare; r = -0.362, P = .0177 with glare; Spearman rank correlation coefficient) and fourth-order root mean square (r = -0.586, P = .0001 and r = -0.306, P = .0450, respectively). Furthermore, significant correlation was found between the amount of myopic correction and the induced changes in log mesopic contrast sensitivity (r = -0.442, P = .0038 without glare; r = -0.464, P = .0024 with glare). The induced changes in higher-order aberrations significantly correlated with the amount of myopic correction (P < .0001, Pearson correlation coefficient).

CONCLUSIONS

Mesopic contrast sensitivity after overnight orthokeratology is deteriorated significantly as ocular higher-order aberrations increase, and these changes depend on the amount of myopic correction.

Ten-year follow-up of laser in situ keratomileusis for high myopia

PURPOSE

To evaluate the long-term outcomes of laser in situ keratomileusis (LASIK) for high myopia.

DESIGN

A long-term (10 years) follow-up retrospective interventional case series study.

METHODS

The study included 196 myopic eyes of 118 patients with a mean preoperative spherical equivalent of -13.95 +/- 2.79 diopter (D) treated with myopic LASIK at the Instituto Oftalmológico de Alicante, Spain using the VISX 20/20 excimer laser (VISX Inc, Santa Monica, California, USA) and the Automated Corneal Shaper microkeratome (Chiron Vision, Irvine, California, USA). All patients were evaluated three months, one year, two years, five years, and 10 years postoperatively. The main outcome measures were refractive predictability and stability, mean corneal keratometry, topographical cylinder, safety, efficacy, stability of visual acuity, and postoperative complications.

RESULTS

At 10 years, 82 (42%) of 196 eyes were within +/-1.00 D and 119 (61%) were within +/-2.00 D. Fifty-four (27.5%) eyes underwent retreatments attributable to under correction and/or regression. The myopic regression decreases with time in eyes that did not undergo retreatment with a mean rate of -0.25 +/- 0.18 D per year. Eleven eyes (5%) lost more than 2 lines of best spectacle-corrected visual acuity (BSCVA) and 78 eyes (40%) showed a postoperatively uncorrected visual acuity of 20/40 or better. Two eyes (1%) with more than 15 D myopic correction developed corneal ectasia.

CONCLUSIONS

LASIK for myopia over -10 D is a safe procedure with myopic regression that slows down with time and a high rate of BSCVA increase in the long-term.

Topography-guided CATz Versus Conventional LASIK for Myopia With the NIDEK EC-5000: A Bilateral Eye Study

PURPOSE

To evaluate the difference in visual acuity, subjective night vision glare, and higher order aberrations in eyes with myopia with or without astigmatism operated with topography-guided customized corneal LASIK and conventional LASIK.

METHODS

This contralateral study includes 46 eyes (23 patients) that underwent topography-guided corneal customized LASIK using the customized aspheric treatment zone (CATz) ablation profile in one eye and conventional LASIK using the NIDEK EC-5000 Advanced Vision Excimer laser system (NAVEX) in the other eye for myopia with or without astigmatism. Patients were masked to which eye underwent topography-guided CATz or conventional LASIK. Postoperative glare and root-mean-square (RMS) values for total higher order aberrations were measured at 1 and 3 months and compared between the two eyes.

RESULTS

No significant difference was noted in uncorrected visual acuity between the two groups at 1 and 3 months postoperatively. Of all patients, 81% stated glare was higher in conventionally treated eyes than in the CATz-treated eyes at 1 and 3 months postoperatively. The RMS values for total coma (0.2385 vs 0.1522) and spherical aberration (0.2381 vs 0.1058) in conventionally treated and CATz-treated eyes were significantly higher in conventionally treated eyes (P=.029 and P=.004, respectively) at 3-month follow-up.

CONCLUSIONS

Topography-guided corneal customized LASIK with the CATz profile gave better night vision quality as compared to conventional LASIK with expanded treatment zone. Better night vision quality was associated with less induced spherical aberrations and coma postoperatively in the CATz treatment group.

Functional outcome and patient satisfaction after Artisan phakic intraocular lens implantation for the correction of myopia

PURPOSE

To determine patient satisfaction after Artisan phakic intraocular lens (PIOL) implantation to correct myopia.

DESIGN

Non-comparative prospective case series.

METHODS

One hundred twenty eyes of 60 patients who had undergone Artisan PIOL implantation to correct myopia were analyzed. A validated questionnaire that consisted of 66 satisfaction items were self-administered by patients 12 months after surgery. Clinical parameters (PIOL decentration, the difference between pupil size and PIOL optical zone, and optical aberrations) were measured. Main outcome measures of satisfaction scale scores (global satisfaction, quality of uncorrected and corrected vision, night vision, glare, day and night driving) were analyzed. Correlations with clinical parameters were obtained.

RESULTS

After surgery, 98.3% of patients were satisfied, and 73.3% of patients considered their night vision to be the same or better; 44.1% of patients reported more bothersome glare. The night vision score correlated with spheric aberration (r = -0.303; P = .020). The glare score correlated with the difference between scotopic pupil size and PIOL optical zone (r = -0.280; P = .030) and vertical coma (r = -0.337; P = .009). The night driving score correlated with postoperative spheric equivalent (r = 0.375; P = .009), total root mean square aberrations (r = -0.337; P = .017), higher order root mean square aberrations (r = -0.313; P = .027), and vertical coma (r = -0.297; P = .036).

CONCLUSION

Overall satisfaction after Artisan PIOL implantation for myopia is excellent. The quality of night vision and night driving were related to scotopic pupil size, individual higher order aberrations, and residual refractive error.

The Refractive Status and Vision Profile: Evaluation of psychometric properties and comparison of Rasch and summated Likert-scaling

The psychometric properties of the Refractive Status and Vision Profile (RSVP) questionnaire were evaluated using Rasch analysis. Ninety-one myopic patients from a refractive surgery clinic and general optometric practice completed the RSVP. Rasch analysis of the RSVP ordinal data was performed to examine for unidimensionality and item reduction. The traditional Likert-scoring system was compared with a Rasch-scored RSVP and a reduced item Rasch-scored RSVP. Rasch analysis of the original RSVP showed poor targeting of item difficulty to patient quality of life, items with a ceiling effect and underutilized response categories. Combining the underutilized response scales and removal of redundant and misfitting items improved the internal consistency and targeting of the RSVP, and the reduced 20-item Rasch scored RSVP showed greater relative precision over standard Likert scoring in discriminating between the two subject groups. A Rasch scaled quality of life questionnaire is recommended for use in refractive outcomes research.

Factors influencing patient choice of refractive surgery or contact lenses and choice of centre

PURPOSE

To explore patient demographics and motivations in choosing refractive surgery (RS) or contact lenses (CL) and factors influencing their choice of practice.

METHODS

A questionnaire was presented to 212 RS and 115 CL patients at four RS centres and three CL centres, respectively. The authors, with consent from the clinics and patients, collected all data. No patient or clinic refused to participate in the study.

RESULTS

There was no statistical difference between RS and CL groups for gender (p = 0.28), although in both groups more females presented than males. The mean age of RS patients was 39.2 +/- 10.6 years and for CL patients was 32.0 +/- 12.4 years (p < 0.0001). The occupational differences between RS and CL patients were found to be significant (p < 0.0001). Primary motivations for RS or CL were cosmesis and inconvenience of CL and spectacles. The main reason why RS patients did not choose CL was due to the inconvenience; there was little difference in this whether patients had previously worn CL or not. CL patients did not choose refractive surgery due to lack of information and apprehension. RS and CL patients selected their respective centres primarily due to reputation.

CONCLUSIONS

Refractive surgery appears increasingly to be a lifestyle choice, possibly based on perceptions and psychological aspects that need to be investigated. The popularity of cosmesis as a highly popular factor for RS and CL patients, together with a few patients citing minor contact lens complications suggests that contact lens clinicians may be able to hold onto patients through better management.

A Quality of Life Comparison of People Wearing Spectacles or Contact Lenses or Having Undergone Refractive Surgery

PURPOSE

To demonstrate the use of the Quality of Life Impact of Refractive Correction (QIRC) questionnaire for comparing the quality of life of pre-presbyopic individuals with refractive correction by spectacles, contact lenses, or refractive surgery.

METHODS

The 20-item QIRC questionnaire was administered to 104 spectacle wearers, 104 contact lens wearers, and 104 individuals who had undergone refractive surgery (N = 312). These groups were similar for gender, ethnicity, socioeconomic status, and refractive error. The main outcome measure was QIRC overall score (scaled from 0 to 100), a measure of refractive correction related quality of life. Groups were compared for overall QIRC score and on each question by analysis of variance, adjusted for age, with post hoc significance testing (Sheffé).

RESULTS

On average, refractive surgery patients scored significantly better (mean QIRC score 50.2 +/- 6.3, F(2,309) = 15.18, P < .001) than contact lens wearers (46.7 +/- 5.5, post hoc P < .001) who were in turn significantly better than spectacle wearers (44.1 +/- 5.9, post hoc P < .01). Convenience questions chiefly drove the differences between groups, although functioning, symptoms, economic concerns, heath concerns, and well being were also important. Spectacle wearers with low strength prescriptions (46.18 +/- 5.05) scored significantly better than those with medium strength prescriptions (42.74 +/- 6.08, F(2,190) = 3.66, P < .05, post hoc P < .05). A small number (n = 7, 6.7%) of refractive surgery patients experienced postoperative complications, which impacted quality of life (37.86 +/- 2.13).

CONCLUSIONS

Quality of life was lowest in spectacle wearers, particularly those with higher corrections. Contact lens wearers had significantly better QIRC score than spectacle wearers. Refractive surgery patients scored significantly better than both. However, this was accompanied by a small risk of poor quality of life due to postoperative complications. The QIRC is an effective outcome measure for quality of life impact of refractive correction.