Ongoing results of excimer laser photorefractive keratectomy for myopia: subjective patient impressions

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.

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.

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.

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

PURPOSE

To determine the relative importance of patients' motives for having laser in situ keratomileusis (LASIK) for myopia.

SETTING

The Corneal Diseases and Excimer Laser Research Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland.

METHODS

Twenty-one cards printed with potential reasons for having LASIK and 3 blank cards for respondents to include additional motives were posted to 71 patients who had myopic LASIK. The cards were ranked by each respondent in order of personal importance and returned for analysis.

RESULTS

The response rate was 77.5%. The mean age of the 19 male and 37 female respondents was 41.7 years +/- 9.3 (SD) and the mean preoperative spherical equivalent, -9.26 +/- 4.58 diopters. The primary reasons for seeking treatment (percentage of respondents ranking topic within the top 5) were improvement of unaided social vision (69.1%), intolerance to spectacles/contact lenses (65.5%), and freedom from spectacles/contact lenses (61.8%). Almost 70% of respondents ranked 1 of these reasons as the most important. General inconvenience of spectacles/contact lenses and the desire to pursue sports and leisure activities also ranked high (52.7% and 36.4%, respectively).

CONCLUSIONS

Consistent with previous work, better unaided vision, combined with the inconvenience of or intolerance to spectacles or contact lenses, provided the main incentives to have LASIK for myopia, while improved cosmesis was relatively unimportant (29.1%). The results of this study will allow the design of satisfaction questionnaires that are better directed toward establishing satisfaction of specific, relevant functional and psychological aspects of refractive surgery that are important to patients.

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.

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

PURPOSE

To identify factors that motivate patients to seek laser in situ keratomileusis (LASIK) treatment for myopia and establish subjective levels of functional improvement and satisfaction across a range of indices after LASIK surgery.

SETTING

The Corneal Diseases and Excimer Laser Research Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland.

METHODS

In this questionnaire-based, cross-sectional study, an anonymous 34-item questionnaire was forwarded to 50 consecutive patients in a prospective study who had had LASIK for high myopia by a single surgeon at a single center. The questionnaire used visual analog scales, anchored at each end by an adjectival descriptor. The mean preoperative myopia was -10.7 diopters +/- 4.4 (SD). Seventy-six percent of eyes (83% of patients) achieved post-LASIK uncorrected visual acuity (UCVA) of 6/12 or better; 1 eye lost 2 lines of corrected Snellen visual acuity.

RESULTS

A 98% reply rate was achieved. The most common motivating factor for pursuing LASIK was to improve UCVA (88%); only 21% rated improved cosmesis as an important motive. Most patients (81% to 100%) reported functional improvement across the spectrum of visual tasks assessed, although 8.8% reported difficulty with nighttime driving. Ninety-six percent felt their UCVA was as good as anticipated, 97.9% were satisfied with the speed of visual improvement, 93.8% achieved the goals for which they had surgery, 97.9% reported an improved quality of life, and 97.9% were satisfied with the overall outcome of LASIK.

CONCLUSIONS

Using an anonymous, wide-ranging questionnaire, high levels of functional improvement and satisfaction with the speed of visual recovery and outcome were reported by patients after LASIK for high myopia. Nighttime driving symptoms of variable severity were, however, noted by 8.8% of patients, despite high levels of satisfaction with other aspects of visual function.

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.

Psychological aspects of excimer laser surgery for myopia: reasons for seeking treatment and patient satisfaction

AIMS

To determine the reasons patients seek excimer laser treatment for myopia and to measure levels of patient satisfaction with each phase of this relatively new treatment.

METHODS

A unique 38 item visual analogue questionnaire was developed and applied to 100 consecutive patients (n = 100) who had undergone excimer laser photorefractive keratectomy for myopia or myopic astigmatism at a single centre. All subjects underwent extensive ophthalmic assessment and patient education before treatment.

RESULTS

A 90% response rate was achieved (n = 90). Improved unaided vision (85.6%), freedom from spectacles (83.3%), and difficulties with contact lens wear (72.7%) were the most common reasons for seeking treatment. The majority of patients felt that the quality of their life had improved (85.5%) and 82% felt that the quality of their unaided vision was as good as they had anticipated. overall, 95.5% of patients were pleased that they had undergone this procedure. The vast majority (98.9%) of patients felt that they fully understood the operation pretreatment but almost one quarter (23.9%) found the actual operation distressing. Only 15.7% found postoperative pain did not respond adequately to prescribed analgesia.

CONCLUSIONS

This study demonstrates a very high level of patient satisfaction after excimer laser treatment for myopia and myopic astigmatism. It suggests that most patients seek treatment to enjoy better vision free from optical aids and that a high level of patient education preoperatively may establish realistic expectations and satisfaction with overall outcome.

Automatic Eye Tracker for Excimer Laser Photorefractive Keratectomy

Acute overlapping of successive laser pulses onto the cornea during photorefractive keratectomy (PRK) is important to avoid refractive distortions. Most excimer laser systems performing corneal ablation lack control of the patient's eye movements and they cannot track the target corneal zone. We developed an eye-tracker based on television monitoring of the pupil and on automatic electro-mechanical deflection of the laser turning mirror, and we applied it to the ExciMed UV200 ArF work station (Summit Technology, Inc., Waltham, Mass.). Basic components are a black and white CCD camera and two fast stepping motors. The circuitry for target discrimination and tracking, and the optical imaging system are designed specifically. The tracker assembly does not interfere with the laser beam path nor with the operator's observation. Tracking of the pupil has been successfully achieved on different color irides, with an accuracy better than 0.1 mm in a 6 x 6 mm2 tracking field. Response time is less than 100 ms. Recordings of eye movements during PRK are presented. Tracking ablations have been performed on moving test eye-balls with plastic corneas. The proposed automatic system appears to be a reliable and effective method for the compensation of patient eye movements appears to be a reliable and effective method during PRK procedures.