Defining the content of patient questionnaires: reasons for seeking laser in situ keratomileusis for myopia

Acupuncture for dry eye syndrome after refractive surgery: A randomized controlled pilot trial

Background

Dry eye syndrome is the most common complication of refractive surgery. Acupuncture is widely used for the treatment of ophthalmologic diseases, but to date, few have explored the effects of acupuncture for the treatment of this condition following refractive surgery. The objective of this study is to assess the feasibility of a study design for evaluating the effectiveness of acupuncture treatment along with usual care compared with usual care only for dry eye syndrome after refractive surgery.

Methods

A total of 18 patients with dry eye syndrome occurring after refractive surgery participated in this study. For 4 weeks, the acupuncture plus usual care and usual care only groups received treatment three times a week. A series of assessments, namely the ocular surface disease index (OSDI), visual analog scale for ocular discomfort, quality of life, tear film break-up time, Schirmer 1 test, and fluorescein-stained corneal-surface photography, along with other general assessments were carried out.

Results

Although preliminary, changes in OSDI from the baseline values were significantly different between the two groups at week 5 (p = 0.0003). There was a significant difference in the trends of OSDI changes between the acupuncture plus usual care and the usual care only groups (p = 0.0039). No serious adverse events were reported during the study.

Conclusion

Four weeks of acupuncture treatment in addition to usual care is a feasible treatment for dry eye syndrome after refractive surgery. A full-scale randomized controlled trial is needed to confirm the clinical effectiveness of acupuncture.

Reasons for Laser in Situ Keratomileusis in China: A Qualitative Study

SIGNIFICANCE

Myopia is a major health issue in East Asian countries, especially in China. By identifying Chinese patients' motivations for laser in situ keratomileusis (LASIK) surgery, our results are expected to help clinicians counsel patients before LASIK surgery and to maximize patients' post-operative LASIK surgery satisfaction, improving the quality of LASIK surgery services.

PURPOSE

Laser in situ keratomileusis has become a popular type of refractive surgery for the correction of myopia worldwide. This study uses qualitative inquiry approaches to understand the motives and processes of patients' LASIK surgery decision making.

METHODS

A purposive sample of 45 patients who had decided to undergo LASIK was recruited. Our qualitative study used in-depth interviews and used content analysis to interpret the data.

RESULTS

Among 45 participants, 48.9% reported that career requirements were the most important reason for seeking LASIK surgery. The inconvenience of wearing glasses or lenses during activities of daily life was also a primary motive. Improving facial appearance was a main reason for female but not male respondents. Potential complications of spectacles and contact lenses in addition to maturation of LASIK technology were also reported motives to seek surgery. Participants gave multiple, overlapping reasons for LASIK surgery.

CONCLUSIONS

These findings suggest that motives to seek LASIK surgery are not only a desire to correct refractive error but also social factors and confidence in improved surgical technology. The implications for clinicians are to be aware of these multiple motives for LASIK to improve the quality and effectiveness of health services for myopia patients.

The Characteristics of Excimer Laser Refractive Surgery Candidates

PURPOSE

To determine the demographic and refractive characteristics of excimer laser refractive surgery candidates in Iran.

METHODS

This was a cross-sectional study between 2010 and 2014. All information was collected from 28 centers randomly selected from 12 provinces. Then, for each season of the year, one week was chosen through simple random selection, and within each week, 3 days were again chosen randomly. All excimer laser surgical procedures performed during these 3 days were identified by training staff, and data were extracted from patient charts.

RESULTS

A total of 14,569 charts were reviewed; 67.5% of the subjects were female and the rest were male. Of the total surgeries, 18.6% had been done in 2010 which reached to 19.1% in 2014. The mean age of people receiving refractive surgery showed an upward trend (P<0.001) and female patients were significantly younger than male patients (P<0.001). The 25 to 39 years age group received the highest number of surgeries (31.9% of the total) and there was a significant association with gender (P<0.001). The most common refractive error was compound myopic astigmatism with a prevalence of 79.3%. In 2010, 33.3% of the performed surgeries were covered by insurance policies, and this decreased to 30.2% in 2014 (P<0.001).

CONCLUSION

Women with compound myopic astigmatism in the age range of 25 and 35 years are the most frequent users of excimer laser refractive surgery. Less than one-third of laser refractive surgeries are covered by insurance policies. Therefore, proper planning for improving services to this group must be given priority.

Contamination of contact lens storage cases of asymptomatic refractive surgery candidates

PURPOSE

To examine the rates of contamination of contact lens storage cases of refractive surgery candidates and compare the growth yields of the traditional method of culturing and a broth-based method.

METHODS

Thirty contact lens storage cases of 16 asymptomatic refractive surgery candidates were studied. Samples from the lens storage case fluid were inoculated into Bactec Peds Plus F broth (Becton Dickinson) and also directly onto blood agar, chocolate agar, and Sabouraud dextrose agar ("traditional method"). Another sample was processed for amoebal contamination. The rate of contamination of cases and the types of pathogens were evaluated for the broth-based and traditional culturing methods. Correlation between right and left storage cases of the same patient was defined as contamination of the two compartments with the same pathogen or pathogens. To avoid statistical bias, only one compartment was included in the study for these patients.

RESULTS

Four storage cases were omitted due to growth correlation between right and left storage cases. Of the remaining 26 storage cases, 16 (61.5%) were found to be contaminated using the broth-based method and 10 (38.5%) using the traditional method (P=.011). High contamination rates were observed regardless of the type of disinfecting solution or type of contact lens used.

CONCLUSIONS

The broth-based method had significantly greater culture yield than the traditional method. The high rates of contamination of contact lens storage cases of refractive surgery patients may put this cohort at greater risk than non-contact lens wearing candidates for developing postoperative infections.

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.

Preoperative Characteristics of Patients Undergoing LASIK in 1997 Versus 2004 at One Surgical Eye Center in China

PURPOSE

To compare the preoperative characteristics of LASIK patients undergoing surgery in 1997 versus 2004 at one of the principal eye surgical centers in China.

METHODS

Preoperative data of patients who underwent LASIK in 1997 and 2004 were recorded and retrospectively compared.

RESULTS

In 1997, the mean spherical equivalent refraction of the 824 eyes of 428 patients undergoing LASIK surgery was -7.30 +/- 4.65 diopters (D), with a mean patient age of 24.67 +/- 6.76 years. Students represented 45.05% of patients undergoing surgery in 1997. In 2004, the mean spherical equivalent refraction of the 8434 eyes of 4286 patients undergoing LASIK surgery was -6.66 +/- 3.31 D, with a mean patient age of 25.20 +/- 6.59 years. Students represented >50% of patients undergoing surgery in 2004. There were significant differences in the constitution ratio of occupation and the spherical equivalent refractions between 1997 and 2004 (t=-2.712, chi-squared=25.117, respectively, P<.05).

CONCLUSIONS

At our center in China, the majority of LASIK patients are young and have myopia ranging from -3.00 to -10.00 D. Students were much more likely than any other occupation to undergo LASIK. The number of patients undergoing LASIK at our center in China has increased exponentially from 1997 to 2004, with an average annual increase in surgical volume of approximately 40%.

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.

Changes in quality of life after laser in situ keratomileusis for myopia

PURPOSE

To measure quality of life (QoL) outcome in prepresbyopic myopic patients having laser in situ keratomileusis (LASIK) refractive surgery using the Quality of Life Impact of Refractive Correction (QIRC) questionnaire and to compare the QoL of preoperative patients with a sample of spectacle and contact lens wearers not considering refractive surgery.

SETTING

Department of Optometry, University of Bradford, Bradford, and Ultralase, Leeds, West Yorkshire, United Kingdom.

METHODS

The validated QIRC questionnaire was prospectively completed by 66 patients before and 3 months after LASIK. Patients had myopia greater than 0.50 diopters (D) (range --0.75 to --10.50 D) and were aged 16 to 39 years. Patients were also directly asked to evaluate their QoL after surgery.

RESULTS

Overall QIRC scores improved after LASIK from a mean of 40.07+/- 4.30 (SD) to 53.09+/- 5.25 (F(1,130)=172.65, P<.001). Greater improvements occurred in women (53.83+/- 5.46) than in men (49.39+/- 5.94; F(1,64)=9.37, P<.005). Overall, 15 of the 20 questions (especially convenience, health concerns, and well-being questions) showed significantly improved scores (P<.05). Patients who "strongly agreed" (53.96+/- 4.91, n=33) or "agreed" (51.78+/- 6.19, n=23) had improved QoL and had significantly higher QIRC scores than those who "neither agreed nor disagreed" (44.36+/- 4.97, n=5) or "strongly disagreed" (42.82, n=1) (F(1,60)=11.24, P<.001). The matched group not contemplating LASIK scored 42.41 +/- 3.89 on QIRC overall.

CONCLUSIONS

Large improvements in QIRC QoL scores were found after LASIK for myopia in the majority of patients, with greater improvements in women. A small number of patients (4.5%) had decreased QIRC QoL scores, and these were associated with complications. People presenting for LASIK scored measurably poorer than matched patients not contemplating refractive surgery.

Patient Motivation for Laser in situ Keratomileusis in the State of Bihar

PURPOSE

To evaluate the main reasons for seeking laser in situ keratomileusis (LASIK) and patient satisfaction after surgery in the socioeconomically underdeveloped eastern state of Bihar, India.

METHODS

This retrospective study evaluated results of the first 100 consecutive patients (169 eyes) who had LASIK at our center from July 2002 to September 2003.

RESULTS

Of the 100 patients, 65% were male and 35% were female. Ninety percent of male patients were between 18 and 24 years old; they sought LASIK to achieve an uncorrected visual acuity of 6/6 to 6/9-the basic qualifying criterion for jobs in the railway and defense services. Eighty-six percent of female patients were of marrying age. At 1 month after LASIK, 93% of patients achieved an UCVA of 6/6, 4% had UCVA between 6/9 to 6/12, and only 1% had <6/60.

CONCLUSION

In the socioeconomically poor state of Bihar, the main reason for males in our study to seek LASIK was to enhance their job prospects. In females, the main reason was to improve facial appearance in order to enhance marriage prospects.

Reasons patients recommend laser in situ keratomileusis

PURPOSE

To evaluate the reasons patients who have had laser in situ keratomileusis (LASIK) recommend it to others and examine the disparity between high levels of satisfaction and patient reports of night-vision symptoms and/or dry eye after LASIK.

SETTING

Northeastern Eye Institute, Scranton, and the University of Pittsburgh, Pittsburgh, Pennsylvania, and the University of California at Los Angeles, Los Angeles, California, USA.

METHODS

Questionnaires assessing symptoms and satisfaction after LASIK were mailed to 2,100 patients. The questionnaires included items about night-vision symptoms and satisfaction and an open-ended question for patients to give their reasons for recommending LASIK to others. The open-ended responses were categorized and tabulated.

RESULTS

Four hundred thirty-four patients provided reasons for recommending LASIK to others. Sixteen categories of reasons were identified. "No more spectacles/contact lenses" was listed by 180 patients (42%), followed by "better vision" (21%) and "convenience" (15%). Women were significantly more likely to cite "better comfort" (27 women versus 3 men; chi square = 8.99, P =.003) and "better quality of life" (41 women versus 9 men; chi square = 7.36, P =.007) as a reason for recommending LASIK. Of the 35 patients who reported dissatisfaction with post-LASIK vision, 20 (57%) would recommend LASIK to a friend because "LASIK helps others."

CONCLUSIONS

Categories of reasons for recommending LASIK to others were similar to reasons given by patients for seeking LASIK. Some patients who reported dissatisfaction with their vision said they would recommend LASIK, suggesting that recommendation of LASIK to others is not necessarily a measurement of the quality of a patient's vision after LASIK.