Development of a Questionnaire to Assess Subjective Vision Score in Myopes Seeking Refractive Surgery

PURPOSE

To assess vision in patients with myopia and myopic astigmatism before and after refractive surgery.

METHODS

A prospective controlled study of visual quality amongst myopes and astigmatic myopes. Focus groups, ophthalmic surgeons, and questionnaire experts devised a Subjective Vision Questionnaire (SVQ), modified after a pilot trial. Participants were administered the SVQ before clinical evaluation. Items answered by over 95%, with factor loadings > 0.55 were included. Test-retest reliability was assessed by repeat testing. Factor analysis identified groups of questions measuring particular dimensions of data.

RESULTS

Sixty-seven items were answered by 128 patients and reduced to 24 items in a final questionnaire. Factor analysis identified six types of questions within the questionnaire, the most important of which was related to driving.

CONCLUSION

The simplicity, low cost, and psychometric properties of the Subjective Vision Questionnaire support its use clinically and in research.

An Informal Satisfaction Survey of 200 Patients After Laser in situ Keratomileusis

PURPOSE

Patient satisfaction following laser in situ keratomileusis (LASIK) is commonly reported as high. This paper reviews the outcome of LASIK both in terms of visual results and satisfaction.

METHODS

Two-hundred patients were surveyed telephonically to establish their degree of satisfaction with LASIK and to enquire about postoperative use of glasses, and symptoms of light sensitivity and of night vision problems. Patient anonymity was assured.

RESULTS

The majority of patients (95%) never wore distance glasses after LASIK. Reading glasses were used by 49 (24.5%), related to age and presbyopia. Light sensitivity was not a problem or was unchanged from baseline in 73% of patients; 27% said they were worse; a few (5.5%) said their symptoms were better. Night vision was not a problem or was unchanged from baseline in 76% of patients; 24% said they were worse; 17% said their symptoms were better. One hundred ninety-five patients (97.5%) were extremely happy with their results and 197 (98.5%) would have the procedure again.

CONCLUSION

After LASIK, 95% of 200 patients wore no distance optical correction; 99% would have the procedure again; and light sensitivity and night vision problems bothered a significant number of patients.

Diplopia as a complication of laser in situ keratomileusis surgery

A case is presented of a patient with high myopia who developed vertical binocular diplopia after decentred laser in situ keratomileusis (LASIK) surgery with associated decompensation of pre-existing exophoria into an exotropia. A 40-year-old man underwent LASIK surgery for high myopia in his right eye. Preoperatively, he was approximately -26.00/-2.00 x 35 degrees with visual acuity of 6/12(-2) in that eye. He also had an asymptomatic exophoria. After LASIK surgery, he achieved a refraction of -3.25/-0.50 x 80 degrees with 6/21 best-corrected visual acuity. He also developed binocular diplopia. The ablation zone had been decentred upwards and there was also an exo- and hypo-deviation of his right eye. He was able to superimpose the two images in free space with vertical and horizontal prisms.A hard contact lens also resulted in superimposition of the two images. Vertical decentration of the ablation zone can induce a vertical prism effect after LASIK surgery and result in vertical diplopia. This together with abnormal optics also caused loss of best-corrected vision and decompensation of his pre-existing exophoria into an exotropia.

Functional outcome and satisfaction after photorefractive keratectomy. Part 2: survey of 690 patients

PURPOSE

To document patient satisfaction and self-perceived quality of vision after bilateral photorefractive keratectomy (PRK).

DESIGN

Noncomparative, interventional case series.

PARTICIPANTS

Consecutive patients who underwent bilateral PRK from May 1994 through May 1997 by the 12 surgeons of four collaborating centers with a minimum of 4 months since the last surgery and up to 30 months since the first surgery.

METHODS

A questionnaire with known psychometric properties was self-administered by the patients.

MAIN OUTCOME MEASURES

Responses to individual questions and scale scores.

RESULTS

A total of 929 questionnaires were sent, of which 690 were answered and returned (74.3% response rate). The preoperative spherical equivalent ranged from -0.38 diopters [D] to -27.75 D (mean, -5.32 D; standard deviation, 2.85 D). Although 91.8% of the patients were satisfied or very satisfied with their surgery, 96.3% considered that their main goal had been reached, and 95.7% would still choose to have surgery if they had it to do over. The degree of satisfaction was proportional to the postoperative uncorrected visual acuity in the best eye expressed in LogMAR (r = -0.18, P: = 0. 0001) and was negatively correlated with the importance of the corneal haze (r = -0.23, P = 0.0001). Daytime glare was reported to be greater than before surgery by 55.1% of patients. A decrease in night vision was reported by 31.7% of patients, and 31.1% of patients reported increased difficulty driving at night because of their vision.

CONCLUSIONS

Overall satisfaction after PRK for low to severe myopia appears to be very good. Glare and night vision disturbance, particularly bothersome for night driving, seem to constitute significant secondary effects that deserve further investigation and should be kept in mind for future improvements in the technique.

Results of bilateral photorefractive keratectomy

OBJECTIVE

To study the refraction and potential risks of bilateral photorefractive keratectomy for myopia.

DESIGN

Retrospective, noncomparative case series.

PARTICIPANTS

Four hundred eighteen consecutive patients (836 eyes) with myopia from -18 to -0.50 diopters (D) had bilateral simultaneous refractive surgery.

INTERVENTION

Refractive surgery was performed with the Nidek EC-5000 slit-scanning excimer laser (Nidek Co., Tokyo, Japan).

MAIN OUTCOME MEASURES

Manifest refraction, Snellen best spectacle-corrected visual acuity (BSCVA) and uncorrected visual acuity, haze, and halos were evaluated for 12 months after surgery. Both eyes of each patient were examined at the same follow-up after initial treatment.

RESULTS

At 12 months after surgery, 95% of eyes were within +/- 1D of emmetropia, and 0.4% of patients had residual anisometropia more than 2 D. Thirty-three eyes (3.9%) were retreated, whereas 5 patients (1.2%) had retreatments in both eyes. Odds ratios between unilateral versus bilateral postoperative events were evaluated for the retreatments (1:0.22; P = 0.001), undercorrections more than 1 D (1:0.17; P < 0.0001), overcorrections more than 1 D (1:0.23; P < 0.0001), loss of 1 line of BSCVA (1:0.44; P < or = 0.002), and loss of 2 lines of BSCVA (1:0.18; P = 0.013). At 12 months after surgery, one eye with a loss of 2 lines of BSCVA was treated for haze more than 1; the fellow eye had haze 0.75. No patient had bilateral haze more than 1. At 12 months after surgery, no patient lost 2 lines of BSCVA in both eyes. There was a higher incidence of halos in both eyes rather than in one eye only (odds ratio: 4.17; P < 0.0001). No postoperative infections occurred.

CONCLUSIONS

Bilateral events occurred approximately 2.5 to 4 times less often than unilateral events, except for the incidence of halos. The calculated odds ratio did not show an increased risk for the fellow eye while performing bilateral surgery, although not exempted from the risk of infection. It may be difficult to predict a complication in the fellow eye based on the results of the first operated eye.

Satisfaction after Photorefractive Keratectomy

PURPOSE

To evaluate patient satisfaction one year after photorefractive keratectomy (PRK) for myopia and myopia astigmatism using the Nidek EC-5000 excimer laser.

METHODS

This study assessed the level of satisfaction of 6280 patients who underwent PRK after a minimum follow-up of 1 year. All patients were asked to enter their level of satisfaction as excellent, good, worthwhile, or disappointed into a networked computer database. Their responses were subsequently analyzed according to baseline and postoperative refractive data.

RESULTS

Patients considered their results to be as follows: 82.3% good or excellent, 14.9% worthwhile, and 2.8% were disappointed with the outcome.

CONCLUSION

A high percentage of patients were satisfied with the outcome following PRK. However, a fair number (14%) of patients considered the treatment to be worthwhile but it did not meet their expectations. Extensive counseling and inculcating realistic expectations before treatment is essential in achieving better patient satisfaction.

Patient Satisfaction after Photorefractive Keratectomy for Low Myopia Using the Visual Analogue Scale

OBJECTIVE

To subjectively assess patient satisfaction after photorefractive keratectomy (PRK) for low myopia using the visual analogue scale.

METHODS

We evaluated the satisfaction of 28 patients (53 eyes) who underwent PRK. Their baseline myopia ranged from -0.50 to -5.00 diopters (D) with a refractive cylinder ranging between plano to -2.00 D. They were all treated using the Nidek EC-5000 scanning excimer laser with an ablation zone diameter of 5.5 mm and a transition zone diameter of 7.0 mm. Mean follow-up time was 11 months.

RESULTS

Mean satisfaction in this group of patients was 90.95 +/- 8.9%. We found that age, baseline astigmatism, postoperative refraction, and postoperative haze influenced the satisfaction outcome.

CONCLUSION

Satisfaction assessment after PRK in patients with low myopia using the visual analogue scale is simple, subjective, reproducible, quick, and probably reliable.

Patient Satisfaction after 5.0-mm Photorefractive Keratectomy for Myopia

PURPOSE

To examine patient satisfaction following photorefractive keratectomy (PRK) in a large number of subjects.

METHODS

We used a questionnaire to examine overall patient satisfaction in 173 patients (173 first-operated eyes) at least 1 year after they had undergone PRK. Mean preoperative spherical equivalent refraction was -7.05 +/- 3.73 D (range, -1.50 to -15.00 D). Fifty-one patients had unilateral surgery and 122 had bilateral surgery, 60 of whom had follow-up of 1 year for both eyes. Visual and refractive results, the use of corrective lenses, and subjective side effects were also studied.

RESULTS

Eighty percent of 173 patients reported they were satisfied or very satisfied with the surgical outcome, while 19.7% reported they were dissatisfied. The average satisfaction score was 7.92 +/- 2.22 out of a possible 10. After PRK, 77.5% reported improvement or great improvement in their general quality of life; 16.8% were very disturbed by subjective visual symptoms. Of the 51 bilateral patients, 85% required no corrective lenses after surgery. Patients who had bilateral operations were more satisfied than those who had unilateral ones. Statistically significant associations were found between patient satisfaction and initial refraction: as preoperative refraction increased, percentage of satisfied or very satisfied patients decreased.

CONCLUSION

Patient satisfaction after PRK was generally high, but subjective visual symptoms remain a problem.

Screening for Psychiatric Distress and Low Self-esteem in Patients Presenting for Excimer Laser Surgery for Myopia

BACKGROUND

Patients presenting for photorefractive keratectomy (PRK) may have unusual psychological profiles. Certain psychological variables may impact treatment outcome, making early identification crucial. We report a controlled questionnaire study of psychiatric "anxiety/distress" and self-esteem in myopic patients who presented for excimer laser treatment.

METHODS

Ninety consecutive myopic individuals (patients) who presented for excimer laser PRK and 50 consecutive myopic individuals who presented to an optometrist for contact lens fitting (controls) were assessed using two self-completion questionnaires-the GHQ30 and Hudson Index of Self-Esteem ISE. The questionnaires were distributed during assessment for treatment.

RESULTS

PRK patients had a 90% response rate for both questionnaires and control patients, 98% for GHQ30 and 100% for Hudson ISE. PRK patients were significantly older (p = 0.000003), had a greater myopic spherical equivalent refraction (p = 0.012) and had better spectacle-corrected visual acuity (p = 0.0096). No significant differences were demonstrated with regard to anxiety/distress in terms of absolute scores (p = 0.07), or the proportion of patients being positive or negative (p = 0.10). Similarly, self-esteem was not significantly different between the two groups (absolute scores p = 0.69; positive/negative p = 0.29). The high response rate shows that the GHQ30 and Hudson ISE are easy to use and well tolerated by myopes in a busy clinic setting. The fact that the patients were older, with a greater refractive error, may partly reflect the onset of contact lens intolerance.

CONCLUSION

The psychological findings suggest that PRK patients cannot be considered more distressed or anxious than other myopic individuals. There is no evidence that their decision to undergo surgery is driven by abnormally low self-esteem.

Comparison of Photorefractive Keratectomy for Myopia Using 5 mm and 6 mm Diameter Ablation Zones

BACKGROUND

We compared the 5 mm and 6 mm ablation zones of the Summit Omnimed in the treatment of myopia in 2 eyes of the same patient.

METHOD

One hundred and twenty-four consecutive patients with myopia less than 6 diopters (D) has one eye treated with a 5 mm ablation zone and the other eye with a 6 mm ablation zone. Minimum follow up was 6 months.

RESULTS

Follow-up was achieved in 101 patients of the total 124. In the 5 mm group 79% achieved 20/30 uncorrected visual acuity while 68% of the 6 mm group achieved 20/30 acuity. Ninety-seven percent of all eyes in both groups achieved 20/40. Some of the disparity between the 20/30 acuity in the two groups is that initial corrections with the 6 mm zones were conservative. Corneal haze was less in the 6 mm group; subjectively they had better night vision.

CONCLUSIONS

Both lasers with the different ablation zones gave reasonably predictable correction of myopia of up to -6 D. Overcorrection and corneal haze were less in the 6 mm group and night vision was subjectively better.

Effect of Photorefractive Keratectomy On Visual Functioning and Quality of Life

The authors present the results of the psychosocial outcomes of 45 patients undergoing excimer laser photorefractive keratectomy (PRK). The patients were evaluated by means of self-report questionnaires preoperatively and 6 months after surgery to determine the effect of uncorrected vision change on the patients quality of life. The measurements include the following variables: clinical end points (spherical equivalent refraction); visual function (night driving, day driving, near vision, far vision, glare disability); functional status (physical, social, and role functioning, mental status); general well-being (health perceptions, personal well-being, overall quality of life); and satisfaction with surgery (expectations, satisfaction with medical staff, postoperative pain, satisfaction with treatment outcomes). Preliminary results indicate that changes of uncorrected vision after PRK are reflected by improvement in each of the quality-of-life functions.