Mesopic pupil indices as potential risk factors for glare disability after intraocular implantable collamer lens implantation: prospective study

PURPOSE

To explore the influence of preoperative factors, including varying pupil sizes and refractive attributes, on postoperative glare disability in patients undergoing implantable collamer lens (ICL) implantation.

SETTING

Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China.

DESIGN

Prospective observational study.

METHODS

The preoperative ocular characteristics and 6-month postoperative glare status in eligible patients who underwent EVO-Visian ICL V4c (VICMO) implantation were analyzed. The glare disability criteria encompassed a glare symptom score >6 and glare sensitivity exceeding 1:2.7. Logistic regression analysis was used to explore the relationship between the preoperative ocular parameters and post-ICL glare.

RESULTS

The study included 95 patients (mean age, 26.04 ± 6.29 years), comprising 30 men (58 eyes) and 65 women (129 eyes). Multivariate analysis revealed a significant correlation between postoperative glare disability and increased spherical power in preoperative mesopic pupils (β = -0.124, P = .039), as well as elevated cylinder power in preoperative mesopic (β = -0.412, P = .009) and photopic pupils (β = -0.430, P = .007). Moreover, a larger preoperative mesopic pupil diameter (β = 0.561, P = .005) demonstrated a significant correlation with glare disability.

CONCLUSIONS

Preoperative mesopic pupil dimensions and associated refractive parameters, such as sphere and cylinder, were correlated with glare disability, including the cylinder aspect in photopic pupils, which can assist clinicians in optimizing preoperative selection for ICL implantation, aiding in the anticipation of potential glare disability risks.

BCLA CLEAR Presbyopia: Epidemiology and impact

The global all-ages prevalence of epidemiologically-measured 'functional' presbyopia was estimated at 24.9% in 2015, affecting 1.8 billion people. This prevalence was projected to stabilise at 24.1% in 2030 due to increasing myopia, but to affect more people (2.1 billion) due to population dynamics. Factors affecting the prevalence of presbyopia include age, geographic location, urban versus rural location, sex, and, to a lesser extent, socioeconomic status, literacy and education, health literacy and inequality. Risk factors for early onset of presbyopia included environmental factors, nutrition, near demands, refractive error, accommodative dysfunction, medications, certain health conditions and sleep. Presbyopia was found to impact on quality-of-life, in particular quality of vision, labour force participation, work productivity and financial burden, mental health, social wellbeing and physical health. Current understanding makes it clear that presbyopia is a very common age-related condition that has significant impacts on both patient-reported outcome measures and economics. However, there are complexities in defining presbyopia for epidemiological and impact studies. Standardisation of definitions will assist future synthesis, pattern analysis and sense-making between studies.

Evaluating patient-reported outcome measures (PROMs) for future clinical trials in adult patients with optic neuritis

OBJECTIVE

To search for and critically appraise the psychometric quality of patient-reported outcome measures (PROMs) developed or validated in optic neuritis, in order to support high-quality research and care.

METHODS

We systematically searched MEDLINE(Ovid), Embase(Ovid), PsycINFO(Ovid) and CINAHLPlus(EBSCO), and additional grey literature to November 2021, to identify PROM development or validation studies applicable to optic neuritis associated with any systemic or neurologic disease in adults. We included instruments developed using classic test theory or Rasch analysis approaches. We used established quality criteria to assess content development, validity, reliability, and responsiveness, grading multiple domains from A (high quality) to C (low quality).

RESULTS

From 3142 screened abstracts we identified five PROM instruments potentially applicable to optic neuritis: three differing versions of the National Eye Institute (NEI)-Visual Function Questionnaire (VFQ): the 51-item VFQ; the 25-item VFQ and a 10-item neuro-ophthalmology supplement; and the Impact of Visual Impairment Scale (IVIS), a constituent of the Multiple Sclerosis Quality of Life Inventory (MSQLI) handbook, derived from the Functional Assessment of Multiple Sclerosis (FAMS). Psychometric appraisal revealed the NEI-VFQ-51 and 10-item neuro module had some relevant content development but weak psychometric development, and the FAMS had stronger psychometric development using Rasch Analysis, but was only somewhat relevant to optic neuritis. We identified no content or psychometric development for IVIS.

CONCLUSION

There is unmet need for a PROM with strong content and psychometric development applicable to optic neuritis for use in virtual care pathways and clinical trials to support drug marketing authorisation.

Quality of vision after myopic refractive surgeries: SMILE, FS-LASIK, and ICL

BACKGROUND

To characterize the quality of vision after SMILE, FS-LASIK, and ICL implantation and evaluate the related factors.

METHODS

131 eyes of 131 myopic patients (90 female, 41 male) who underwent refractive surgeries including SMILE (35 patients), FS-LASIK (73 patients), and ICL implantation (23 patients) were analyzed. The Quality of Vision questionnaires were completed 3 months after surgery, and the results were characterized and analyzed with baseline characteristics, treatment parameters, and postoperative refractive outcomes using logistic regression analysis to find out predicted factors.

RESULTS

Mean age was 26.5 ± 4.6 years (range: 18 to 39 years) and mean preoperative spherical equivalent was - 4.95 ± 2.04 diopters (D) (range: -1.5 to -13.5). Safety and efficacy index was comparable between different techniques: the safety index was 1.21 ± 0.18, 1.22 ± 0.18, and 1.22 ± 0.16 and the efficacy index were 1.18 ± 0.20, 1.15 ± 0.17, 1.17 ± 0.15 for SMILE, FS-LASIK and ICL respectively. The mean overall QoV score was 13.40 ± 9.11, with mean frequency, severity, and bothersome score of 5.40 ± 3.29, 4.53 ± 3.04, and 3.48 ± 3.18 respectively, and there was no significant difference between different techniques. Overall, the symptom with the highest scores was glare, following fluctuation in vision and halos. Only the scores of halos were significantly different among different techniques (P < 0.000). Using ordinal regression analysis, mesopic pupil size was identified as a risk factor (OR = 1.63, P = 0.037), while postoperative UDVA was a protective factor (OR = 0.036, P = 0.037) for overall QoV scores. Using binary logistic regression analysis, we found that patients with larger mesopic pupil size had an increased risk to experience glare postoperatively; compared to ICL, patients who underwent SMILE or FS-LASIK tended to report fewer halos; patients with better postoperative UDVA were less likely to report blurred vision and focusing difficulty; with larger residual myopic sphere postoperatively, patients experienced focusing difficulties and difficulty judging distance or depth perception more frequently.

CONCLUSIONS

SMILE, FS-LASIK, and ICL had comparable visual outcomes. Overall, glare, fluctuation in vision, and halos were the most frequently experienced visual symptoms 3 months postoperatively. Patients with ICL implanted tended to report halos more frequently compared with SMILE and FS-LASIK. Mesopic pupil size, postoperative UDVA, and postoperative residual myopic sphere were predicted factors for reported visual symptoms.

Patient-reported outcome measures in vitreoretinal surgery: a systematic review

This review article systematically reviews the use of Patient Reported Outcome Measures (PROMs) in Vitreoretinal surgery, with the aim of recommending a preferred PROM-tool for use in clinical practice. Vitreoretinal surgery lags behind other ophthalmic subspecialties in the adoption of PROMs as a core outcome measure of success post-operatively. Current outcomes rely heavily on post-operative Best Corrected Visual Acuity (BCVA) and anatomical success on imaging modalities such as Ocular Coherence Tomography (OCT), despite the link between each of these measures and patient satisfaction being uncertain. We systematically reviewed the available literature in March 2021, in accordance with PRISMA guidelines, searching six databases: MEDLINE, EMBASE, Web of Science, APA PsycINFO, SCOPUS and Cochrane Library. Critical appraisal of PROM-tools was facilitated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist. We identified 14 eligible original research papers that used PROMs as a primary or secondary outcome of success post-operatively in patients having undergone vitreoretinal surgery. Eight different generic and vision-related PROM-tools were identified as being used in vitreoretinal studies, none of which were vitreoretinal-disease-specific. Our review article considers whether generic-health PROMs (e.g., EQ5D) or vision-related PROMs (e.g. NEI VFQ-25) are precise or responsive enough following vitreoretinal surgery to have a meaningful impact on clinical or research practice. We also consider the importance of standardisation of clinical outcomes in vitreoretinal clinical trials.

The Vision Correction Questionnaire: an electronic patient-reported outcome measure for refractive surgery

PURPOSE

To develop a psychometrically robust electronic patient reported outcome measure (ePROM) for refractive surgery.

SETTING

Moorfields Eye Hospital, London, United Kingdom.

DESIGN

Questionnaire development study.

METHODS

Items were derived in 6 domains (spectacle dependence, visual quality, eye comfort, functional freedom, emotional wellbeing, and satisfaction with treatment) from existing Rasch adjusted instruments, patient and surgeon feedback, and refinement in semistructured interviews before administration to a field test cohort (n = 360) of patients undergoing routine refractive surgery. Spectacle dependence and satisfaction with treatment items were used to provide descriptive statistical information only. Contemporary criteria for item reduction and Rasch modeling were applied to the remaining domains. The finalized questionnaire was then administered to a second patient cohort (n = 120) before and after surgery to assess sensitivity to change.

RESULTS

A 5-item scale derived for emotional wellbeing was unidimensional and a good fit to the Rasch model with ordered category response profiles, adequate precision (person separation 2.22 logits, reliability coefficient 0.83), and no misfitting items. Mean logit scores were 0.91 higher after treatment (effect size 1.26) suggesting a positive impact on emotional wellbeing. Functional scales could not be derived for visual quality, eye comfort, or functional freedom. Single-item ratings for visual quality and eye comfort were retained in our final 11-item questionnaire.

CONCLUSIONS

This short ePROM should integrate well with routine clinical care and clinical trials in refractive surgery. The Rasch adjusted emotional wellbeing scale may help quantify the way patients feel about refractive surgery, with the remaining items providing useful descriptive information.

Evaluating patient-reported outcome measures (PROMs) for clinical trials and clinical practice in adult patients with uveitis or scleritis: a systematic review

Patient reported outcome measures (PROMs) capture impact of disease and treatment on quality of life, and have an emerging role in clinical trial outcome measurement. This study included a systematic review and quality appraisal of PROMs developed or validated for use in adults with uveitis or scleritis. We searched MEDLINE, EMBASE, PsycINFO, CINAHL and grey literature sources, to 5 November 2021. We used established quality criteria to grade each PROM instrument in multiple domains from A (high quality) to C (low quality), and assessed content development, validity, reliability and responsiveness. For instruments developed using classic test theory-based psychometric approaches, we assessed acceptability, item targeting and internal consistency. For instruments developed using Item Response Theory (IRT) (e.g. Rasch analysis), we assessed response categories, dimensionality, measurement precision, item fit statistics, differential item functioning and targeting. We identified and appraised four instruments applicable to certain uveitis types, but none for scleritis. Specifically, the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ), a 3-part PROM for Birdshot retinochoroiditis (Birdshot Disease & Medication Symptoms Questionnaire [BD&MSQ], the quality of life (QoL) impact of Birdshot Chorioretinopathy [QoL BCR], and the QoL impact of BCR medication [QoL Meds], the Kings Sarcoidosis Questionnaire (KSQ), and a PROM for cytomegalovirus retinitis. These instruments had limited coverage for these heterogeneous conditions, with a focus on very rare subtypes. Psychometric appraisal revealed considerable variability between instruments, limited content development, and only one developed using Item Response Theory. In conclusion, there are few validated PROMs for patients with uveitis and none for scleritis, and existing instruments have suboptimal psychometric performance. We articulate why we do not recommend their inclusion as clinical trial outcome measures for drug licensing purposes, and highlight an unmet need for PROMs applicable to uveitis and scleritis.

Quality of life impact of eye diseases: a Save Sight Registries study

BACKGROUND

The objectives of this study were to evaluate the quality-of-life (QoL) impact of eye diseases (keratoconus; neovascular age-related macular degeneration, AMD; retinal vein occlusion, RVO; and diabetic macular edema, DME) using the Impact of Vision Impairment (IVI) questionnaire, and to determine the relationship between the IVI scores and visual acuity.

METHODS

This cross-sectional, multicentre, real-world study utilised the prospective, web-based Save Sight Registries. The IVI was completed by 1557 patients: 307 with keratoconus, 1049 with AMD, 148 with RVO and 53 with DME. Statistical analysis included Rasch analysis, Welch t-test, one-way ANOVA, Tukey's test, Pearson correlation, and multiple regression.

RESULTS

The IVI scales (Overall; Visual Function, VF; Emotional, EM) had robust psychometric properties. The keratoconus patients had the worst Overall (adjusted mean: 48.2 vs. DME 58.8, RVO 64.6, AMD 67.6 units), VF (47.7 vs. DME 59.4, RVO 65.9, AMD 68.9 units) and EM (50.8 vs. DME 63.1, RVO 69.2, AMD 71.8 units) scores (all p < 0.05). The IVI scales scores weakly correlated with better and worse eye visual acuity (Pearson's r 0.24-0.39, all p < 0.05). The correlations were similar in the better eye (Overall 0.35, VF 0.39, EM 0.24) and the worse eye (Overall 0.31, VF 0.33, EM 0.25) visual acuity. Correlations with visual acuity were stronger for VF than for the EM scores.

CONCLUSIONS

The IVI was a psychometrically robust QoL questionnaire. Keratoconus patients had worse IVI scores than patients with retinal diseases. The low strength of correlations between visual acuity and QoL scores, although statistically significant, suggested that a complex relationship exists.

Impact of DMEK on visual quality in patients with Fuchs' endothelial dystrophy

PURPOSE

To investigate short-term (3 months follow-up) changes in visual quality following Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy (FED).

METHODS

In this prospective institutional case series, 51 patients that underwent DMEK for FED were included. Assessment included the Quality of Vision (QoV) questionnaire preoperatively, at 1 month, and 3 months after surgery. Secondary outcome measures were anterior segment parameters acquired by Scheimpflug imaging, corrected distance visual acuity (CDVA), and endothelial cell density (ECD).

RESULTS

Glare, hazy vision, blurred vision, and daily fluctuation in vision were the symptoms mostly reported preoperatively. All symptoms demonstrated a significant reduction of item scores for severity, frequency, and bothersome in the course after DMEK (P < 0.01). Glare and fluctuation in vision remained to some extent during the follow-up period (median score = 1). Preoperatively, corneal densitometry correlated moderately to weakly with severity of hazy vision (r_s = 0.39; P = 0.03) and frequency (r_s = 0.26; P = 0.02) as well as severity (r_s = 0.27; P = 0.03) of blurry vision. CDVA and central corneal thickness (CCT) did not correlate with visual complains.

CONCLUSIONS

Following DMEK for FED, patient-reported visual symptoms assessed by the QoV questionnaire represent a useful tool providing valuable information on the impact of DMEK on visual quality that cannot be directly estimated by morphological parameters and visual acuity only.

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.

Halim N. The Quality of Life Impact Refractive Correction (QIRC) questionnaire: validation of the Malay-translated version of the QIRC using Rasch analysis

BACKGROUND

The Quality of Life Impact Refractive Correction (QIRC) questionnaire is a Rasch-validated instrument to assess the quality of life of ametropes with refractive correction. The original QIRC was validated in the United Kingdom. This study aimed to validate the Malay version of the QIRC among refractive correction wearers in Malaysia using Rasch analysis.

METHODS

The original 20-item QIRC was forward-backward translated into Malay in preparation for the Pilot Malay QIRC. The pilot version was pre-tested on 105 spectacle/contact lens-corrected myopes, and the results were reviewed and cross-culturally adapted to produce the Final Malay QIRC. The final version was self-administered to a new sample of 304 participants. A Rasch analysis was conducted to evaluate the items and response categories of the Pilot and the Final Malay QIRC. Test-retest reliability was also analysed on the Final Malay QIRC.

RESULTS

Based on the pre-test findings, Rasch analysis revealed a multidimensional scale (functional scale [Items 1 to 13] and emotional scale [Items 14 to 20], which were separated in subsequent analysis), unordered response categories for the functional scale (Category 3 was collapsed into Category 2), one misfit item (Item 3 was removed) and six items required modification (Items 4, 6 to 9, and 12 were reworded and cross-culturally adapted). In the Final Malay QIRC, both the functional and emotional scales had ordered response categories, good person reliability (functional, 0.80; emotional, 0.81) and separation index (functional, 2.01; emotional, 2.06), well-targeted items (targeting precision: functional, 0.28 logits; emotional, 0.08 logits), and satisfactory fit statistics (infit and outfit mean square were less than 1.50 for all items). A noticeable differential item functioning (DIF) between genders was found in Item 18 (DIF contrast, 0.40 logits; p = 0.04). Test-retest reliability analysis demonstrated a high intraclass correlation coefficient (0.94) and Cronbach's alpha (0.97) with a coefficient of repeatability of ±8.14 units.

CONCLUSIONS

The Malay-translated version of the QIRC has good psychometric characteristics for assessing the quality of life of refractive correction wearers in Malaysia. This translated and cross-culturally adapted Malay QIRC is a valid and reliable instrument that can be used in routine clinical practice.

Reliability and Validity of the Persian Version of Quality of Life Impact of Refractive Correction Questionnaire

PURPOSE

To evaluate the psychometric properties of the Persian version of quality of life impact of refractive correction (QIRC) questionnaire and its utility in assessment of refractive error-related quality of life (QoL) following photorefractive keratectomy (PRK).

METHODS

Patients with low-to-moderate myopia (-0.75 to - 6.0) were enrolled in this study. Standard alcohol-assisted PRK was performed in all patients. The QIRC questionnaire was translated into a Persian version using the standard method. Patients completed QIRC questionnaire preoperatively and 3-month postoperatively. A group of patients completed the questionnaire twice preoperatively. Psychometric properties were evaluated by internal consistency (Cronbach's α), item-total correlation, and known group construct validity. Intraclass correlation coefficient (ICC) were used to examine the repeatability.

RESULTS

One hundred forty-seven patients (60 males and 87 females) with a mean age of 26.3 ± 5.5 (range, 18-39) years were enrolled. Cronbach's α for total score was 0.923. Item-total correlation was above 0.3 for all items. ICC was 0.978 for total score. Preoperatively, predominantly contact lens wearers showed significantly better total QIRC score than predominantly spectacle wearers (P = 0.017), which showed good known group validity. Total QIRC score significantly increased from 41.31 ± 6.69 preoperatively to 50.47 ± 7.26 postoperatively (P < 0.0001). Improvement in total QIRC score was observed both in contact lens wearers and spectacle wearers.

CONCLUSION

The Persian version of QIRC questionnaire is a valid and reliable tool. Refractive error-related QoL assess by QIRC was significantly improved after PRK in an Iranian population.

Computational study for temperature distribution in ArF excimer laser corneal refractive surgeries using different beam delivery techniques

Refractive errors are the most common causes of vision impairment worldwide and laser refractive surgery is one of the most frequently performed ocular surgeries. Clinical studies have reported that approximately 10.5% of patients need an additional procedure after the surgery. The major complications of laser surgery are over/under correction and dry eye. An increase in temperature may be a cause for these complications. The purpose of this study was to estimate the increase in temperature during laser refractive surgery and its relationship with the complications observed for different surgical techniques. In this paper, a finite element model was applied to investigate the temperature distribution of the cornea when subjected to ArF excimer laser at a single spot using various beam delivery systems (broad beam, scanning slit, and flying spot). The Pennes bio-heat equation was used to predict the temperature values at different laser pulse energies and frequencies. The maximum temperature increase by ArF laser ([Formula: see text] frequency and [Formula: see text] pulse energy) at a single spot was [Formula: see text] for [Formula: see text] diopter correction ([Formula: see text] of ablation of corneal stroma) using broad beam, scanning slit, and flying spot beam delivery approaches respectively. The peak temperature due to a single pulse was estimated to be [Formula: see text]. Although the peak temperature (sufficient energy to break intermolecular bonds) exists for a very short time ([Formula: see text]) compared to the thermal relaxation time ([Formula: see text]), there is some thermal energy exchange between corneal tissues during a laser refractive surgery. Heating may cause collagen denaturation, collagen shrinkage, and more evaporation and hence proposed to be a risk factor for over/under correction and dry eye.

Effect of Wavefront Aberrations on Night Vision Problems and Mesopic Contrast Threshold After SMILE

PURPOSE

To investigate the effect of wavefront aberrations on night vision problems and mesopic contrast threshold after small incision lenticule extraction (SMILE).

METHODS

Forty-two participants (84 eyes) who underwent SMILE were included in this prospective observational study. Visual outcomes including uncorrected distance visual acuity (UDVA), subjective manifest refraction, mesopic contrast threshold (Binoptometer 4P; Oculus Optikgeräte GmbH), and higher order aberrations (HOAs) were analyzed before and 3 months after surgery. The patient's night vision satisfaction was assessed using a questionnaire.

RESULTS

The mean spherical equivalent was -5.30 ± 1.38 diopters (D) preoperatively and -0.06 ± 0.15 D postoperatively. UDVA was better than 20/20 in 98.81% of the patients and better than 20/25 in all patients. Scores of night vision satisfaction and glare changed significantly in the postoperative period (F = 8.463, P = .001; F = 69.518, P < .001, respectively). Preoperative spherical diopters (lower order aberrations) were positively correlated with night vision satisfaction (r = -0.329, P = .041) and glare score (r =-0.332, P = .039). Age (odds ratio [OR] = 1.272, 95% CI = 1.019 to 1.589) and preoperative spherical diopter (OR = 0.437, 95% CI = 0.199 to 0.975) were correlated with night vision satisfaction scores by analysis of binary regression. The root mean square value of total HOAs increased 3 months after surgery (t = -6.873, P < .001) with an increase in horizontal coma (Z₃¹) and spherical aberration (Z₄⁰) (P < .001). No correlation was observed between glare score and HOAs; however, patients with higher preoperative myopia demonstrated continuously decreasing contrast under mesopic conditions and higher postoperative horizontal coma.

CONCLUSIONS

Myopic patients with higher preoperative spherical errors experienced more glare at night after SMILE surgery. Postoperative horizontal coma was associated with worse mesopic contrast thresholds. [J Refract Surg. 2021;37(7):446-452.].

An evaluation of instruments measuring behavioural aspects of the nurse-patient relationship

The Fundamentals of Care Framework is an evidence-based, theory-informed framework that conceptualises high-quality fundamental care. The Framework places the nurse-patient relationship at the centre of care provision and outlines the nurse behaviours required for relationship development. Numerous instruments exist to measure behavioural aspects of the nurse-patient relationship; however, the literature offers little guidance on which instruments are psychometrically sound and best measure the core relationship elements of the Fundamentals of Care Framework. This study evaluated the quality of nurse-patient relationship instruments by (1) assessing their content development and measurement properties (e.g. dimensionality, targeting, reliability, validity) and (2) mapping instrument content to the Framework's core relationship elements: trust, focus, anticipate, know, and evaluate. Twenty-seven instruments were evaluated. Findings demonstrated that patients and nurses were rarely involved in item development. Most instruments exhibited poor measurement properties, with only one instrument having complete information on all quality indicators. Instrument content focused primarily on nurses getting to know patients and earning their trust, with only 54, 18, and 1 item(s), respectively, measuring 'focus', 'anticipate' and 'evaluate'. Hence, there does not appear to be a robust instrument measuring behavioural aspects of nurse-patient relationships, nor one capturing the relationship elements of the Fundamentals of Care Framework.

IMI Impact of Myopia

The global burden of myopia is growing. Myopia affected nearly 30% of the world population in 2020 and this number is expected to rise to 50% by 2050. This review aims to analyze the impact of myopia on individuals and society; summarizing the evidence for recent research on the prevalence of myopia and high myopia, lifetime pathological manifestations of myopia, direct health expenditure, and indirect costs such as lost productivity and reduced quality of life (QOL). The principal trends are a rising prevalence of myopia and high myopia, with a disproportionately greater increase in the prevalence of high myopia. This forecasts a future increase in vision loss due to uncorrected myopia as well as high myopia-related complications such as myopic macular degeneration. QOL is affected for those with uncorrected myopia, high myopia, or complications of high myopia. Overall the current global cost estimates related to direct health expenditure and lost productivity are in the billions. Health expenditure is greater in adults, reflecting the added costs due to myopia-related complications. Unless the current trajectory for the rising prevalence of myopia and high myopia change, the costs will continue to grow. The past few decades have seen the emergence of several novel approaches to prevent and slow myopia. Further work is needed to understand the life-long impact of myopia on an individual and the cost-effectiveness of the various novel approaches in reducing the burden.

Quality of Life in Presbyopes with Low and High Myopia Using Single-Vision and Progressive-Lens Correction

This study evaluates the impact of the severity of myopia and the type of visual correction in presbyopia on vision-related quality of life (QOL), using the refractive status and vision profile (RSVP) questionnaire. A total of 149 subjects aged 41-75 years with myopic presbyopia were recruited: 108 had low myopia and 41 had high myopia. The RSVP questionnaire was administered. Rasch analysis was performed on five subscales: perception, expectation, functionality, symptoms, and problems with glasses. Highly myopic subjects had a significantly lower mean QOL score (51.65), compared to low myopes (65.24) (p < 0.001). They also had a significantly lower functionality score with glasses (49.38), compared to low myopes (57.00) (p = 0.018), and they had a worse functionality score without glasses (29.12), compared to low myopes (36.24) (p = 0.045). Those who wore progressive addition lenses (PAL) in the high-myope group (n = 25) scored significantly better, compared to those who wore single-vision distance (SVD) lenses (n = 14), with perception scores of 61.19 and 46.94, respectively (p = 0.029). Highly myopic presbyopes had worse overall QOL and functionality, both with and without glasses, compared to presbyopes with low myopia. High-myopic PAL users had a better perception outcome than SVD lens wearers. Low-myopic PAL wearers had a better QOL than SVD wearers.

Item banks for measurement of refractive error-specific quality of life

PURPOSE

To evaluate the psychometric properties of refractive error-specific quality of life (QoL) item banks and assess their performance using computerised adaptive testing (CAT) simulations.

METHODS

In this cross-sectional study a 392-item questionnaire, grouped under 11 QoL domains, was interviewer-administered to 305 people with refractive error [mean age ± S.D., 30.5 ± 14.1 (range (18 to 83) years; male, 50.5%; mean ± S.D. spherical equivalent refractive error -2.4 ± 2.9 (range: -15.0 to +11.0) Dioptres; spectacles (n = 257), contact lens (n = 37), refractive surgery (n = 25), uncorrected refractive error (n = 57)]. Rasch analysis was conducted on each QoL domain using the Andrich rating scale model to investigate parameters including response category functioning, person- and item-reliability, infit and outfit statistics, unidimensionality, targeting, differential item functioning and local item dependency. The resulting item banks underwent CAT simulations in 1,000 cases with 'high' and 'moderate' precision stopping rules.

RESULTS

Rasch analysis iterations resulted in 13 refractive error-specific item banks (Convenience, Health concerns, Economic, Activity limitation, Mobility, Emotional, Social, Visual symptoms frequency, Visual symptoms severity, Visual symptoms bothersome, Comfort symptoms frequency, Comfort symptoms severity and Comfort symptoms bothersome), containing a total of 366 items. The item banks had good psychometric properties including satisfactory measurement precision, infit and outfit statistics and unidimensionality. In CAT simulations, the mean number of items required to achieve high and moderate measurement precision was 9.4 and 4.7, respectively.

CONCLUSION

Overall, refractive error-specific QoL item banks show promise in their ability to comprehensively and precisely evaluate a range of quality of life parameters. These items banks when administered using a CAT system offer unique outcome tools for implementation in clinical trials, healthcare and research.

Functional Optical Zone and Visual Quality After Small-Incision Lenticule Extraction for High Myopic Astigmatism

Introduction

The aim of this study was to compare the functional optical zone (FOZ) after correction of high myopic astigmatism and low myopic astigmatism by small-incision lenticule extraction (SMILE).

Methods

In this prospective study, 30 patients who received SMILE for high myopic astigmatism correction (cylinderical diopters ≤ − 2.0D) were enrolled in the high astigmatism group (HA). The control group comprised 40 patients who underwent SMILE for low myopic astigmatism correction (LA; cylinderical diopters ≥ − 0.5D). FOZ was delineated as the area outlined by a change of 0.5D relative to the power at the corneal vertex on the total corneal refractive power map. An ellipse-fitting program (MatLab) was used to calculate some parameters of the FOZ. Visual quality evaluations were also conducted, including evaluations of wavefront aberrations, optical quality, and intraocular scattering, and completion of a quality of life questionnaire. All of the right eyes were analyzed in the study.

Results

The preoperative average treatment spherical equivalent (− 5.77 ± 1.86D vs. − 6.49 ± 1.49D; P = 0.074), lenticule thickness (120.87 ± 23.27 μm vs. 118.53 ± 21.66 μm; P = 0.666), and programmed optical zone (6.58 ± 0.17 mm vs. 6.65 ± 0.18 mm; P = 0.104) were comparable between the HA and LA groups. The long axes (6.99 ± 1.14 mm vs. 5.32 ± 0.61 mm; P < 0.001), short axes (4.66 ± 0.96 mm vs. 4.23 ± 0.64 mm; P = 0.047), and area (25.90 ± 8.03 mm² vs. 17.92 ± 4.36 mm²; P < 0.001) of the FOZ were significantly larger in the HA group than in the LA group. The centration of the FOZ were comparable between the two groups (0.62 ± 0.25 mm vs. 0.70 ± 0.25 mm; P = 0.194). Postoperative spherical aberration was lower in the HA group than in the LA group (0.07 ± 0.05 μm vs. 0.14 ± 0.10 μm; P = 0.001). There was no significant difference in the ocular scatter index (0.80 ± 0.46 vs. 0.73 ± 0.46; P = 0.447), modulated transfer function (MTF)_cutoff (37.89 ± 9.79 cpd vs. 39.78 ± 7.45 cpd; P = 0.363), and Strehl in two dimensions (Strehl2D) ratio (0.20 ± 0.04 vs. 0.20 ± 0.04; P = 0.363) between the HA group and the LA group. There were no significant differences in the scores on quality of life between the HA and LA groups (45.88 ± 2.15 vs. 45.64 ± 1.84; P = 0.423). Correlation analysis revealed that increase in the spherical aberration was significantly correlated with the long axes, short axes and area in the FOZ in both groups.

Conclusion

With a comparable optical design and attempted correction in SMILE, the eyes with higher myopic astigmatism correction achieved larger FOZ than the eyes with lower myopic astigmatism correction. Consequently, less spherical aberration induction was created after higher myopic astigmatism correction. This result may be associated with less corneal volume sculpted by laser for the higher astigmatism treatment, leading to fewer biochemical responses and les change in corneal aspherity. Good retinal image quality and satisfied quality of life were achieved at a comparable level in both study groups.

Phakic intraocular lenses: An overview

Phakic intraocular lenses (pIOLs) are a common solution for the surgical correction of high myopia and myopia in thin corneas. Global trends result in increasing rates of patients with high myopia which will result in increased rates of pIOL implantation. Three types of lenses can be distinguished: anterior chamber angle-supported, anterior chamber iris-fixated, and posterior chamber phakic IOLs. The efficacy of phakic intraocular lenses is generally very good, but pIOLs have undergone many changes over the years to improve the safety profile and decrease pIOL-related complications such as endothelial cell loss, corneal decompensation and cataract formation. This article describes the efficacy and safety profiles of the most recent pIOLs, as well as suggests gaps of knowledge that are deserve additional research to optimize the results of pIOLs.

Patient-reported outcome measures in presbyopia: a literature review

Presbyopia is the age-related loss of near-distance focusing ability. The aim of this study was to identify patient-reported outcome measures (PROMs) used in clinical trials and quality-of-life studies conducted in individuals with presbyopia and to assess their suitability for use in individuals with phakic presbyopia. Literature searches were performed in Medline and Embase up until October 2017. Specific search terms were used to identify presbyopia studies that included a PROM. All clinical trials with PROM-supported endpoints in presbyopia were identified on ClinicalTrials.gov. Further searches were conducted to retrieve articles documenting the development and psychometric evaluation of the PROMs identified. A total of 703 records were identified; 120 were selected for full-text review. Twenty-one clinical trials employed PROMs to support a primary or secondary endpoint. In total, 13 PROMs were identified; a further 23 publications pertaining to the development and validation of these measures were retrieved. Most PROMs were developed prior to release of the Food and Drug Administration (FDA) 2009 patient-reported outcome guidance and did not satisfy regulatory standards. The Near Activity Visual Questionnaire (NAVQ) was identified as the most appropriate for assessing near-vision functioning in presbyopia. While the NAVQ was developed in line with the FDA guidance, the items do not reflect changes in technology that have occurred since the questionnaire was developed in 2008 (eg, the increase in smartphone use), and the measure was not validated in a purely phakic presbyopia sample. Further research is ongoing to refine the NAVQ to support trial endpoints related to changes in near-vision functioning associated with phakic presbyopia.

Determinants of subjective patient-reported quality of vision after small-incision lenticule extraction

PURPOSE

To characterize patient-reported long-term quality of vision (QoV) after small-incision lenticule extraction (SMILE), and to identify potential clinical parameters that might predispose to experiencing deteriorated visual quality.

SETTING

University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany.

DESIGN

Prospective cross-sectional study.

METHODS

For the assessment and scoring of visual symptoms, the Quality of Vision questionnaire was employed, which constitutes a clinically validated, linear-scaled 30-item instrument providing a QoV score on three scales (symptom frequency, severity, and bothersome). Subgroup analyses were performed for patient subgroups stratified by baseline characteristics (eg, age) and treatment parameters (eg, surgical refractive correction) as well as refractive outcomes (eg, residual refraction) and visual outcomes (eg, uncorrected distance visual acuity [UDVA]).

RESULTS

The study comprised 394 eyes of 197 patients (117 women [59.4%], 80 men [40.6%]) were included with a mean postoperative follow-up of 24.4 months ± 14.1 (SD). The QoV scores for symptom frequency, severity, and bothersome were 34.63 ± 13.69, 29.60 ± 12.38, and 24.56 ± 16.00, respectively. Patients with a preoperative binocular corrected distance visual acuity (CDVA) of 20/12.5 or better, patients who lost 1 or more lines of UDVA as compared with preoperative CDVA, patients older than the age of 40, and patients with inadvertent anisometropia more than 0.375 diopters reported worse QoV scores.

CONCLUSION

The relationship between objective clinical parameters and patient-reported subjective QoV after SMILE seems complex. Defined prognostic factors that convey a higher risk for experiencing visual disturbances were identifiable and should be discussed with patients seeking SMILE treatment during preoperative counseling.

Constructing Item Banks for Measuring Quality of Life in Refractive Error

SIGNIFICANCE

Existing patient-reported outcome instruments in refractive error are paper-based questionnaires. They are not comprehensive and psychometrically robust. This study has identified the content of the refractive error-specific item banks that aim to provide comprehensive and scientific measurement of refractive error-specific quality of life.

PURPOSE

The purpose of this study was to identify minimally representative, optimally informative, and efficient sets of items for measuring quality of life in people with refractive error.

METHODS

First, items were identified from existing patient-reported outcome instruments. Second, items were developed from qualitative studies with people with refractive error (48 and 101 in-depth interviews in Australia and Nepal, respectively). Third, classification and selection of items were done based on a set of systematic criteria using an iterative process of binning and winnowing. The resulting items underwent cognitive testing with people with refractive error in Australia and in Nepal. Each step was guided by an expert panel consensus.

RESULTS

We retrieved 792 items from the existing patient-reported outcome instruments. From the interviews conducted in Australia, a total of 2367 comments were coded into 807 initial items. Similarly, from the interviews conducted in Nepal, 3477 comments were coded into 914 initial items. After binning and winnowing, followed by cognitive testing, a final set of items comprising 337 items for the Item-pool (Australia) and 308 items for the Item-pool (Nepal), both spanning 12 domains, was obtained. Forty-seven percent of items were common across the two item pools. In the Item-pool (Nepal), 65% items were common for corrected and uncorrected refractive error.

CONCLUSIONS

We identified the content of two different sets of item banks to comprehensively measure the impact of refractive error on quality of life for people in Australia and Nepal, which may be applicable to high-income country settings and low- and middle-income country settings, respectively. Future work aims to develop computer-adaptive testing system to administer the item banks, resulting in useful measurement tools for researchers, clinicians, and policy planners.

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 use of patient-reported outcome research in modern ophthalmology: impact on clinical trials and routine clinical practice

This review article considers the rising demand for patient-reported outcome measures (PROMs) in modern ophthalmic research and clinical practice. We review what PROMs are, how they are developed and chosen for use, and how their quality can be critically appraised. We outline the progress made to develop PROMs in each clinical subspecialty. We highlight recent examples of the use of PROMs as secondary outcome measures in randomized controlled clinical trials and consider the impact they have had. With increasing interest in using PROMs as primary outcome measures, particularly where interventions have been found to be of equivalent efficacy by traditional outcome metrics, we highlight the importance of instrument precision in permitting smaller sample sizes to be recruited. Our review finds that while there has been considerable progress in PROM development, particularly in cataract, glaucoma, medical retina, and low vision, there is a paucity of useful tools for less common ophthalmic conditions. Development and validation of item banks, administered using computer adaptive testing, has been proposed as a solution to overcome many of the traditional limitations of PROMs, but further work will be needed to examine their acceptability to patients, clinicians, and investigators.

Uncorrected and corrected refractive error experiences of Nepalese adults: a qualitative study

PURPOSE

The aim of this study was to explore the impact of corrected and uncorrected refractive error (URE) on Nepalese people's quality of life (QoL), and to compare the QoL status between refractive error subgroups.

METHODS

Participants were recruited from Tilganga Institute of Ophthalmology and Dhulikhel Hospital, Nepal. Semi-structured in-depth interviews were conducted with 101 people with refractive error. Thematic analysis was used with matrices produced to compare the occurrence of themes and categories across participants. Themes were identified using an inductive approach.

RESULTS

Seven major themes emerged that determined refractive error-specific QoL: activity limitation, inconvenience, health concerns, psycho-social impact, economic impact, general and ocular comfort symptoms, and visual symptoms. Activity limitation, economic impact, and symptoms were the most important themes for the participants with URE, whereas inconvenience associated with wearing glasses was the most important issue in glasses wearers. Similarly, possibilities of having side effects or complications were the major concerns for participants wearing contact lens. In general, refractive surgery addressed socio-emotional impact of wearing glasses or contact lens. However, the surgery participants had concerns such as possibility of having to wear glasses again due to relapse of refractive error.

CONCLUSION

Impact of refractive error on people's QoL is multifaceted. Significance of the identified themes varies by refractive error subgroups. Refractive correction may not always address QoL impact of URE but often add unique QoL issues. This study findings also provide content for developing an item-bank for quantitatively measuring refractive error-specific QoL in developing country setting.

Impact of refractive error on quality of life: a qualitative study

IMPORTANCE

This study qualitatively explores the impact of refractive error on adults, particularly after correction.

BACKGROUND

The study aimed to explore the impact of refractive error on quality of life.

DESIGN

Cross-sectional; in-depth telephone and face-to-face semistructured interviews; qualitative study with inductive and deductive processes.

PARTICIPANTS

Forty-eight adults with refractive error (including presbyopia) were recruited from the Flinders Vision, the Ashford Advanced Eye Care and among Flinders University staff and students, in South Australia.

METHODS

The interviews were audio-recorded, transcribed verbatim, coded and analysed using thematic analysis.

MAIN OUTCOME MEASURES

Themes and categories RESULTS: The median age of the participants was 49 years (min: 22 years; max: 76 years). Most of them were female: (29; 59%). Most of them (36; 75.0%) had myopia followed by hyperopia (12; 25.0%). Twenty-two (45.8%) participants had astigmatism. Similarly, 23 (47.9%) of them were presbyopes. Most of the participants (39; 81.3%) wore glasses; 17 (35.4%) used contact lenses, and 17 (35.4%) had undergone refractive surgery. A total of 2367 comments were coded. Thematic analysis resulted into six themes that informed about quality of life issues in people with refractive error. Concerns about cosmetic appearance, personal health and safety, difficulties in day-to-day activities and inconveniences rendered in daily life were identified as the most important themes.

CONCLUSIONS AND RELEVANCE

The findings of this study enrich the understanding on the issues important in people with refractive error. The quality of life issues identified will be used to develop a refractive error-specific item bank.