Effect of the EVO+ Visian Phakic Implantable Collamer Lens on Visual Performance and Quality of Vision and Life.

PURPOSE: To assess the effect of EVO+ (V5) Visian implantable collamer lens implantation on mesopic visual performance, quality of vision (QoV), and quality of life (QoL). DESIGN: Prospective interventional case series. METHODS: Thirty-six eyes of 36 participants who underwent EVO+ implantation for myopia were evaluated preoperatively and at postoperative visits at 1 week and 1, 3, and 6 months. Visual acuity (VA) and mesopic contrast sensitivity (CS) with and without halogen- and xenon-type glare sources were evaluated at each visit. Subjective QoV was assessed with the QoV questionnaire and QoL assessed with the Quality of Life Impact of Refractive Correction (QIRC) questionnaire at each visit. Ring-shaped dysphotopsia was also assessed at each postoperative visit. Linear, cumulative link and logit mixed models were fitted to analyze the effect of the EVO+. RESULTS: Following EVO+ implantation, VA significantly (P ≤ .012) improved at the 4 postoperative visits. Mesopic CS progressively improved at 1, 3, and 6 months postoperatively (P ≤ .012). Halogen glare CS decreased at 1 week and halogen and xenon glare CS improved at 6 months (P ≤ .016). Photostress recovery time after halogen glare improved at 3 and 6 months (P ≤ .004). QoV scores improved at 1 week and 3 and 6 months (P ≤ .001). QIRC scores improved postoperatively (P < .001). Ring-shaped dysphotopsia decreased at 3 and 6 months (P ≤ .007). CONCLUSIONS: EVO+ implantation provides good mesopic visual performance, QoV, and QoL during up to 6 months follow-up. Some activities performed under mesopic conditions with glare sources may be affected during the first postoperative week. Ring-shaped dysphotopsia is negligibly bothersome 6 months after surgery.

Effect of central hole location in phakic intraocular lenses on visual function under progressive headlight glare sources.

PURPOSE: To analyze the effect of the central hole location in the V4c implantable collamer lens (ICL) on the quality of vision, including progressive headlight glare simulation and quality of life. SETTING: IOBA-Eye Institute, Valladolid, Spain. DESIGN: Case series. METHODS: The central hole location was determined by slitlamp and dual Scheimpflug imaging for 6 months or more postoperatively. The visual acuity, mesopic contrast sensitivity, halogen glare contrast sensitivity, xenon glare contrast sensitivity, photostress recovery time after glare, de Boer scale, and Quality of Life Impact of Refractive Correction (QIRC) questionnaire results were evaluated. Multiple regression models were used to analyze the effect of the central hole location on parameters using the pupil center and visual axis as references based on Cartesian and polar coordinates. RESULTS: The safety index was 1.13 and the efficacy index, 1.12. Under all testing circumstances, central hole decentration did not affect the visual acuity or contrast sensitivity. With the visual axis as a reference, worse QIRC values were associated with greater upward central hole displacement (P = .03) and a lower polar angle value (P = .008); also, halogen glare discomfort was greater with a higher radius (P = .04). Using the pupil center as a reference, greater nasal central hole decentration was associated with longer xenon glare photostress recovery time (P = .002). CONCLUSIONS: Implantation of the ICL with a central hole yielded excellent visual outcomes, even under increasing glare sources, regardless of the hole's location. However, hole decentration might affect patient-perceived quality of life, bothersome halogen glare, and longer xenon glare photostress recovery time. Such complaints after the early postoperative period might be managed with discrete ICL centration if the central hole is decentered upward or nasally.

Patient-reported vision-related quality of life after bilateral wavefront-guided laser in situ keratomileusis.

PURPOSE: To evaluate functional vision and quality-of-life outcomes after bilateral wavefront-guided laser in situ keratomileusis (LASIK). SETTING: Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA. DESIGN: Prospective case series. METHODS: Visual acuity, refractive error, and aberrometric measurements were obtained preoperatively and 1, 6, and 12 months after bilateral wavefront-guided LASIK. The Refractive Status and Vision Profile questionnaire scores were completed at each timepoint and compared with baseline scores. RESULTS: The study comprised 84 eyes of 42 patients (aged 24 to 47 years). At 1 year, 76 eyes (90.5%) had an uncorrected distance visual acuity of 20/20 or better and 88.1% of patients were satisfied with their vision without correction. Total refractive status and vision profile scores improved significantly from a mean of 30.9 points at baseline to 20.7 points 1 year postoperatively (P < .001). The visual function, perceptions, and problems with corrective lenses subscales statistically significantly improved from preoperatively to postoperatively (all P < .001). In contrast, the driving (P = .286) and visual symptoms subscales (P = .199) did not show significant changes from baseline to 1 year. CONCLUSION: Wavefront-guided LASIK not only afforded clinically measurable improvements in vision but also significant improvements in subjective functional vision and vision-related quality of life 1 year after surgery.

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.

Assessment of the Psychometric Properties of a Questionnaire Assessing Patient-Reported Outcomes With Laser In Situ Keratomileusis (PROWL).

IMPORTANCE: Patient-reported outcome (PRO) measures for laser in situ keratomileusis (LASIK) are needed. OBJECTIVE: To develop PRO measures to assess satisfaction, eye-related symptoms, and their effect on functioning and well-being following LASIK based on patient and expert input. DESIGN, SETTING, AND PARTICIPANTS: The Patient-Reported Outcomes With LASIK (PROWL) studies were prospective observational studies of patients undergoing LASIK surgery for myopia, hyperopia, or astigmatism. PROWL-1 was a single-center study of active-duty US Navy personnel and PROWL-2 was a 5-center study of civilians. PROWL-1 enrolled 262 active-duty service personnel and PROWL-2 enrolled 312 civilians 21 years or older who spoke English; 241 individuals in PROWL-1 and 280 in PROWL-2 completed a baseline questionnaire before surgery. The analytic sample included those also completing 1 or more follow-up questionnaires: 240 (99.6%) of those in PROWL-1 and 271 (94.4%) of those in PROWL-2. Questionnaires were self-administered through the internet preoperatively and at 1 and 3 months postoperatively in both studies and at 6 months postoperatively in PROWL-1. PROWL-1 began in August 2011 and was completed May 30, 2014; PROWL-2 began in July 2012 and was completed June 27, 2014. Data were analyzed from June 28, 2014, to October 24, 2016. MAIN OUTCOMES AND MEASURES: Scales assessing visual symptoms (double images, glare, halos, and starbursts), dry eye symptoms, satisfaction with vision, and satisfaction with LASIK surgery. Items from the National Eye Institute (NEI) Refractive Error Quality of Life Instrument (NEI-RQL-42), NEI Visual Function Questionnaire (NEI-VFQ), and the Ocular Surface Disease Index (OSDI) were included. All scales are scored on a 0 to 100 possible range. Construct validity and responsiveness to change were evaluated (comparing scores before and after surgery). RESULTS: The median age of the 240-person PROWL-1 analytic sample was 27 years (range, 21-52 years); 49 were women (20.4%). The median age of the 271-person PROWL-2 analytic sample was 30 years (range, 21-57 years); 147 were women (54.2%). Internal consistency reliabilities for the 4 visual symptom scales ranged from 0.96 to 0.98 in PROWL-1 and from 0.95 to 0.97 in PROWL-2. The median (interquartile range) test-retest intraclass correlation was 0.69 (0.57-0.79) and 0.76 (0.68-0.84) in PROWL-1 and PROWL-2, respectively. Product-moment correlations of satisfaction with surgery with visual symptom scales at follow-up evaluations ranged from r = 0.24 to r = 0.49. Measures improved from baseline to follow-up, with effect sizes of 0.14 to 1.98, but scores on the NEI-RQL-42 glare scale worsened at the 1-month follow-up. Hours of work did not change significantly from baseline to 1-month follow-up, with the mean number (mean [SD] difference) in PROWL-1 of 41.7 vs 40.9 hours (-0.8 [18.7]) and in PROWL-2 of 38.8 vs 38.2 hours (-0.6 [17.1]). CONCLUSIONS AND RELEVANCE: The results of these studies support the reliability and validity of visual symptom scales to evaluate the effects of LASIK surgery in future studies.

Symptoms and Satisfaction of Patients in the Patient-Reported Outcomes With Laser In Situ Keratomileusis (PROWL) Studies.

IMPORTANCE: Patient-reported outcomes should be collected using validated questionnaires prior to and following laser in situ keratomileusis (LASIK) surgery. OBJECTIVE: To report the frequency of patient-reported visual symptoms, dry eye symptoms, satisfaction with vision, and satisfaction with LASIK surgery in the Patient-Reported Outcomes With LASIK (PROWL) studies. DESIGN, SETTING, AND PARTICIPANTS: The PROWL-1 and PROWL-2 studies were prospective, observational studies conducted from September 13, 2011, to June 27, 2014. The PROWL-1 study was a single-military center study of 262 active-duty Navy personnel 21 to 52 years of age. The PROWL-2 study was a study of 312 civilians 21 to 57 years of age conducted at 5 private practice and academic centers. The LASIK surgery and the postoperative care were performed based on the usual practice and clinical judgment at the site. Participants completed a self-administered, web-based questionnaire, preoperatively and postoperatively at 1 and 3 months (the PROWL-1 and -2 studies) and at 6 months (the PROWL-2 study). EXPOSURES: Participants underwent LASIK surgery for myopia, hyperopia, and/or astigmatism. MAIN OUTCOMES AND MEASURES: Visual symptoms (double images, glare, halos, and/or starbursts), dry eye symptoms, participant satisfaction (with vision and LASIK surgery), and clinical measures (visual acuity, refractive error, and slitlamp and posterior segment eye examination findings) were assessed preoperatively and at 1, 3, and 6 months postoperatively. RESULTS: A total of 262 participants were enrolled in the PROWL-1 study (mean [SD] age, 29.1 [6.1] years), and a total of 312 participants were enrolled in the PROWL-2 study (mean [SD] age, 31.5 [7.3] years). Visual symptoms and dissatisfaction with vision were common preoperatively. Overall, the prevalence of visual symptoms and dry eye symptoms decreased, although a substantial percentage of participants reported new visual symptoms after surgery (43% [95% CI, 31%-55%] from the PROWL-1 study and 46% [95% CI, 33%-58%] from the PROWL-2 study at 3 months). The percentages of participants in the PROWL-1 study with normal Ocular Surface Disease Index scores were 55% (95% CI, 48%-61%) at baseline, 66% (95% CI, 59%-72%) at 3 months, and 73% (95% CI, 67%-79%) at 6 months. The percentages of participants in the PROWL-2 study with normal Ocular Surface Disease Index scores were 44% (95% CI, 38%-50%) at baseline and 65% (95% CI, 59%-71%) at 3 months. Of those participants who had normal scores at baseline in both the PROWL-1 and -2 studies, about 28% (95% CI, 19%-37%) had mild, moderate, or severe dry eye symptoms at 3 months. While most participants were satisfied, the rates of dissatisfaction with vision ranged from 1% (95% CI, 0%-4%) to 4% (95% CI, 2%-7%), and the rates of dissatisfaction with surgery ranged from 1% (95% CI, 0%-4%) to 2% (95% CI, 1%-5%). CONCLUSIONS AND RELEVANCE: The systematic administration of a questionnaire to patients who have undergone LASIK surgery is a new approach to assess symptoms and satisfaction. Our findings support the need for adequate counseling about the possibility of developing new symptoms after LASIK surgery.

Vision-related quality of life and visual outcomes after small-incision lenticule extraction and laser in situ keratomileusis.

PURPOSE: To compare vision-related quality of life (VRQoL) scores and clinical outcomes between small-incision lenticule extraction and laser in situ keratomileusis (LASIK). SETTING: Singapore National Eye Centre, Singapore. DESIGN: Prospective study. METHODS: Patients had small-incision lenticule extraction using the Visumax 500 kHz femtosecond laser; or LASIK excimer ablation with the Wavelight Allegretto 400 Hz laser. Primary outcomes were 3-month predictability, efficacy, and safety. Secondary outcomes were intraoperative experience, visual symptoms, and VRQoL (validated Quality of Life Impact of Refractive Correction [QIRC] questionnaire) in 25 a subgroup of patients in each group. Following Rasch analysis, "Functional" and "Emotional," QIRC dimensions were analysed separately. RESULTS: At 3 months, predictability (82.5% versus 85.3%, ±0.5 diopters attempted correction, P =.453), safety index (1.13 ± 0.19 [SD] versus 1.07 ± 0.16, P = .158), and efficacy index (0.91 ± 0.21 versus 0.97 ± 0.19; P = .002) were found when comparing small-incision lenticule extraction (172 eyes) and LASIK (matched 688 eyes). Intraoperative experience between groups was not statistically different; visual fluctuations (P = .020) and episodes of visual blurring (P = .008) were greater after small-incision lenticule extraction than after LASIK at 1 month but not at 3 months. There was no difference in "functional" (66.7 ± 15.7 versus 55.3 ± 22.2, P = .064) and "emotional" (42.7 ± 23.2 versus 37.9 ± 23.8, P = .394) QIRC dimensions between the 2 groups (25 patients in each group) at 3 months. CONCLUSION: The study, 3-month predictability, safety, and VRQL scores were not statistically different between small-incision lenticule extraction and LASIK. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Quality of life for amblyopic children and their parents.

AIM: To highlight the changes in the quality of life in patients with anisometric, refractive, strabic and mixed amblyopia and to assess the psychosocial implication for their family. MATERIAL AND METHODS: Prospective observational transversal study of 44 ambulatory pa- tients (88 eyes) treated in the Ophthalmology Clinic of Iasi "Sf. Spiridon" Hospital and Iasi Stereopsis Ophthalmology Clinic. Clinical parameters: visual acuity, objective refraction (autorefractometry), optical correction type, stage of binocular vision, ocular motility, strabic deviation. The patients or their attendants accepted to fill out a questionnaire comprising 46 items pertaining to 9 domains to assess patient (or parents) adherence to treatment and issues related to quality of life. RESULTS: Mean age of study patients was 8.19 ± 2.92 years (range 4-16 years) and age at first diagnosis was: 3.90 ± 2.15 years. Moderate and severe amblyopia in the right eye was present in 47.72% of cases and in the left eye in 43.18%. Right eye uncorrected visual acuity was 0.45 ± 0.31 and corrected 0.63 ± 0.31 (p < 0.0001). Left eye uncorrected visual acuity was 0.49 ± 0.33 and corrected was 0.69 ± 0.32 (p < 0.0001). No statistically significant difference between the right and left eye were found. A 46-item questionnaire focused on child health, visual acuity, binocular vision, time to occlusion or penalization, child emotions/activity, family and society integration was used. CONCLUSIONS: The first presentation to the ophthalmologist was at age 3.9091 ± 2.1597 years (range 3 months-7 years). Health promotion and education is important to determine parents to seek help from an ophthalmologist not later than age 3. The main symptoms that led the parents to seek eye care were: strabic deviation--45.45%, difficulty seeing the blackboard--11.36%, and difficulty in seeing closer--20.45%. Quality life questionnaires detect life or school problems of children with amblyopia and educate parents. In 15.91% of parents they did not knew that before treatment the child had poor school results. This study represents the first step in Romanian ophthalmologists concern for socio-professional integration of children with amblyopia, because as we know some jobs require healthy eyes and for those who do not receive appropriate treatment their dream will be denied.

Utility values among myopic patients in mainland China.

PURPOSE: To elicit utility values of adult myopic patients in mainland China. METHODS: A valid sample of 442 myopia patients (spherical equivalent at least -0.5 diopters) aged 17 to 44 years who were scheduled to undergo refractive surgery were recruited. Information on time trade-off ([TTO] years of life willing to sacrifice for treatment of myopia) and standard gamble (SG) for blindness (risk of blindness from therapy, willing to sacrifice for treatment of myopia) utility values and sociodemographic and clinical data were obtained. RESULTS: The mean utility values based on TTO and SG were 0.96 ± 0.05 (95% confidence interval [CI], 0.95 to 0.96; median, 0.98) and 0.93 ± 0.09 (95% CI, 0.92 to 0.94; median, 0.97), respectively. Myopic patients using contact lens had significantly higher TTO utility values than those wearing glasses (p < 0.001). There was no significant difference in the TTO and SG utility values by age, sex, occupation, educational levels, residence, reasons for refractive surgery, and severity and duration of myopia (p > 0.05). CONCLUSIONS: The TTO and SG produce similar mean utility values, but there is poor agreement between results for individuals from the two methods. Utility values associated with myopic patients obtained in this study or reported in the literature seem to be higher than those obtained for other ophthalmic conditions.

Patient satisfaction and clinical outcomes with laser refractive surgery performed by surgeons in training.

PURPOSE: To evaluate the refractive error quality of life (RQL) improvement, patient satisfaction, and clinical results of laser refractive surgery performed by residents or fellows. SETTING: Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, USA. DESIGN: Case series. METHODS: This study reviewed the clinical results of consecutive refractive surgery cases performed between March 2010 and February 2012 by ophthalmology residents or fellows. One-year postoperative analysis of the RQL and patient satisfaction in a subgroup of patients was completed using the National Eye Institute Refractive Error Correction Quality of Life-42 instrument (NEI RQL-42), and a comparison with NEI published normative data and post-refractive data was performed. RESULTS: Data were obtained from 138 eyes that had laser in situ keratomileusis and 4 eyes that had photorefractive keratectomy. The 1-year postoperative analysis of the RQL and patient satisfaction was completed in 34 patients. After 6 months postoperatively, the mean uncorrected distance visual acuity was 0.01 logMAR (95% confidence interval [CI], -0.012 to 0.023). The mean postoperative residual refractive error spherical equivalent was -0.20 diopter (D) (95% CI, -0.26 to -0.13). No eye lost corrected distance visual acuity. Equivalent or better satisfaction in the RQL was found in all but 1 of the 13 scale scores of the NEI RQL-42 compared with previously published NEI data. CONCLUSIONS: Laser refractive surgery performed by residents and fellows showed high patient satisfaction and an improved RQL 1-year postoperatively. Clinical outcomes validated the safety and efficacy of refractive surgery performed by surgeons in training. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Predictive factors for comorbid psychiatric disorders and their impact on vision-related quality of life in patients with high myopia.

To determine the incidence of depression and anxiety disorders in patients with high myopia as well as the factors that would predict the development of psychiatric complications and their impact on vision-related quality of life (VR-QoL). Two hundred and five patients with pathologic myopia (axial length ≥26.50 mm) were studied. Incidence of depression and anxiety disorders was determined using the Hospital Anxiety and Depression Scale (HADS). VR-QoL was determined by the 25-item National Eye Institute Visual Function Questionnaire. Incidence of depression was 22.0 % and incidence of anxiety disorder was 25.9 %. Absence of children was the only factor significantly associated with the presence of depression, and a past history of cataract surgery was the only factor significantly associated with the presence of anxiety disorder. Factors which decreased the VR-QoL were in order of importance--anxiety disorder, decreased visual acuity in the best eye, depression, and being female. Responses of the subjects to two HADS statements 'I can laugh and see the funny side of things' and 'I can enjoy a good book or radio or television program' identified 82.2 % of depressed patients, and 'I get sudden feelings of panic' and 'I can sit at ease and feel relaxed' identified 71.7 % of patients with anxiety disorder. Twenty-two to 26 % of highly myopic patients had psychiatric disorders which had a strong negative impact on their VR-QoL. Two statements from the HADS questionnaire can be used to screen highly myopic patients for depression or anxiety disorders.

Myopic LASIK in psychiatric patients.

PURPOSE: To evaluate the surgical results obtained in patients with psychiatric disorders who underwent myopic laser in situ keratomileusis. (LASIK). METHODS: Retrospective study of 156 eyes of 82 patients who underwent LASIK to correct a myopic spherical equivalent (SE) at Clínica Baviera-Instituto Oftalmológico Europeo, Bilbao, Spain. All procedures were performed with the Technolas Keracor 217 Z excimer laser. Patients had a preoperative diagnosis of bipolar disorder (79 eyes of 42 patients), schizophrenia (61 eyes of 32 patients), or obsessive-compulsive disorder (16 eyes of 8 patients). Before surgery, the average sphere of the series was -3.92 ± 2.24 D in the first group, -3.45 ± 2.03 D in the second group, and -3.39 ± 1.97 D in the third group. We surveyed the patients to analyze subjective assessment from the patient's perspective. RESULTS: At the last available visit after treatment, we obtained an SE of ±0.50 D in 85.71% of eyes with bipolar disorder, 88.52% of eyes with schizophrenia, and 93.75% of eyes with obsessive-compulsive disorder. The efficacy index was 1.00 ± 0.20 in the first group, 1.03 ± 0.21 in the second group, and 1.00 ± 0.07 in the third group. No eye lost 2 lines or more of best spectacle-corrected visual acuity. CONCLUSIONS: We found that patients with compensated psychiatric disorders, of which the surgeon was aware, achieved excellent results after surgery, with no remarkable complications. Patients tolerated the procedures well and were satisfied.

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

PURPOSE: The aim of this study was to determine how laser in situ keratomileusis (LASIK) affects quality of life (QOL) and to identify factors that may affect satisfaction after LASIK. METHODS: A total of 104 patients with a mean age of 29±6, treated with LASIK for myopia and astigmatism, were enrolled in a prospective study. High (90%) and low (10%) contrast visual acuity (CVA) were measured under photopic and scotopic conditions before surgery and at 3 months later. A multidimensional QOL scale (Institute for Eye Research multidimensional QOL scale), which assesses psychological characteristics, personality traits, cosmesis, frequency, and tolerance to disturbing visual and ocular symptoms, and overall satisfaction with vision correction, was also used. Paired rank tests were used to compare preoperative and postoperative vision and QOL scores. Correlations and a multiple linear regression were used to describe the relationship between CVA, QOL, and satisfaction after LASIK. RESULTS: Significant postoperative changes included increased satisfaction following LASIK (P<0.001), reduced frequency of visual and ocular symptoms (P<0.001), and change in psychological characteristics (P=0.033). The change in satisfaction with LASIK can be predicted by a combination of preoperative satisfaction, postoperative frequency of disturbing visual and ocular symptoms, postoperative mean spherical equivalent, and postoperative scotopic high CVA (R (2)=0.725, P<0.05). CONCLUSIONS: Satisfaction with LASIK is related to visual function, preoperative expectations, psychological characteristics, and uncorrected CVA achieved. An increased sense of subjective well-being, adaptability, and self-efficacy was evident after LASIK. Patients reported a more optimistic attitude to life and increase perceived QOL after surgery.

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.

One-year outcomes of a bilateral randomised prospective clinical trial comparing PRK with mitomycin C and LASIK.

AIM: To compare 1-year follow-up results of photorefractive keratectomy (PRK) with mitomycin C (MMC) and laser in situ keratomileusis (LASIK) for custom correction of myopia. METHODS: Eighty-eight eyes of 44 patients with moderate myopia were randomised to PRK with 0.002% MMC for 1 min in one eye and LASIK in the fellow eye. The 1-year follow-up was evaluated. RESULTS: There were no differences between LASIK and MMC-PRK eyes preoperatively. Forty-two patients completed the 1-year follow-up. MMC-PRK eyes achieved better uncorrected visual acuity (p = 0.03) and better best-spectacle-corrected visual acuity (p<0.001) 1 year after surgery. SE did not differ in the two groups during follow-up (p = 0.12). Clinically significant haze was not found in surface ablation eyes. LASIK eyes showed a greater higher-order aberration (p = 0.01) and lower contrast sensitivity (p<0.05) than MMC-PRK eyes postoperatively. Excellent vision was reported in 64% of LASIK and 74% of MMC-PRK eyes 1 year after surgery. The corneal resistance factor and corneal hysteresis (ORA, Reichert) were higher in LASIK than in MMC-PRK eyes (p<0.01) at the last follow-up. CONCLUSIONS: Wavefront-guided PRK with 0.002% MMC was more effective than wavefront-guided LASIK for correction of moderate myopia. Further research is necessary to determine the optimal concentration, exposure time and long-term corneal side effect of MMC.

Quality of life changes after myopic wavefront-guided laser in situ keratomileusis.

OBJECTIVE: To evaluate the changes in quality of life in patients undergoing wavefront-guided laser in situ keratomeilusis (WG-LASIK). METHODS: Thirty candidates undergoing WG-LASIK were enrolled in a prospective study at the University of Texas Southwestern Medical Center at Dallas, TX. The patients were asked to fill out a questionnaire which had questions pertaining to their quality of life, preoperatively and 3 months postoperatively. The average patients' age was 41.4 +/- 12.45 years, and the preoperative manifest refractive spherical equivalent was -3.62 +/- 1.60 D (-1.00 to -7.50 D). RESULTS: The total quality-of-life score improved from 3.70 +/- 0.91 to 3.90 +/- 0.97 (P = 0.01). Most of the psychologic well-being items like energy level, stress level, self-confidence, sense of safety, and the social role subscale items such as ability to communicate with others, job performance, and sex life showed significant improvement in mean scores (P < 0.05). The postoperative visual function and visual symptom scores, however, were overall similar to preoperative levels. CONCLUSIONS: Consistent with previous studies with conventional LASIK, there is a significant improvement in quality of life after WG-LASIK. The main changes pertain to psychologic well-being and social role, more than the changes in visual function per se. However, the latter did not show evidence of deterioration, nor of worsening of visual symptoms, contrary to some studies with conventional LASIK.

Evaluation of the relationship between ablation diameter, pupil size, and visual function with vision-specific quality-of-life measures after laser in situ keratomileusis.

OBJECTIVE: To evaluate the relationship between ablation diameter, pupil size, and visual function as measured by a vision-specific quality-of-life instrument after undergoing laser in situ keratomileusis. METHODS: Of 300 patients eligible for this study, 97 (32.3%) responded to a mailed study questionnaire, the National Eye Institute Refractive Error Quality of Life (RQL) Instrument. The RQL Instrument was administered in all 97 patients after laser in situ keratomileusis. Spearman correlation coefficients were calculated for the association between RQL subscale scores and characteristics including pupil diameter and uncorrected visual acuity. RESULTS: Positive correlations between larger mesopic and scotopic pupil diameter and higher RQL satisfaction scores (0.12 and 0.19, respectively) were not statistically significant at the P=.05 level. As uncorrected visual acuity in the better eye improved, patients reported significantly less worry (-0.22; P=.03), more satisfaction (-0.25; P=.01), clearer vision (-0.25; P=.01), and better far vision (-0.24; P=.02). CONCLUSION: Larger pupil diameter is not significantly associated with postoperative satisfaction and visual function as measured with the RQL. Rather, postoperative uncorrected visual acuity is confirmed as a strong predictor of patient satisfaction after refractive surgery.

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

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

Functional outcomes and patient satisfaction after laser in situ keratomileusis for correction of myopia.

PURPOSE: To determine subjective patient satisfaction and self-perceived quality of vision after laser in situ keratomileusis (LASIK) to correct myopia and myopic astigmatism. SETTING: Department of Ophthalmology, Academic Hospital Maastricht, Maastricht, The Netherlands. METHODS: A validated questionnaire consisting of 66 items was self-administered by 142 consecutive patients. Seven scales covering a specific aspect of quality of vision were formulated. Aspects included global satisfaction, quality of uncorrected and corrected vision, quality of night vision, glare, daytime driving, and night driving. Main outcome measures were responses to individual questions and scale scores, and correlations with clinical parameters including refractive outcome, uncorrected visual acuity, best corrected visual acuity, ablation depth, and scotopic pupil-optical zone disparity were obtained. RESULTS: The mean score for the overall satisfaction was 4.1 +/- 0.71 (SD) (scale 0 to 5.0). A total of 92.2% of patients were satisfied or very satisfied with their surgery, 93.6% considered their main goal of surgery achieved, and 92.3% would choose to have LASIK surgery again. Satisfaction with uncorrected vision was 3.03 +/- 0.71. The mean score for glare was 3.0 +/- 0.9. At night, glare from lights was believed to be more important than before surgery by 47.2%. Glare from oncoming car headlights after surgery was reported by 58.4% and was believed to be more bothersome for night driving than before surgery by 52.8%. Night driving was rated more difficult than before surgery by 39.4%, whereas 59.3% had less difficulty driving at night. There was a significant correlation between the uncorrected vision score and the postoperative spherical equivalent (r = 0.245) and postoperative astigmatism (r = 0.265). There was no correlation between the glare or night vision scores and the degree of correction, the amount of ablation depth, or the disparity between the scotopic pupil and the optical zone. CONCLUSIONS: Self-perceived uncorrected vision after LASIK surgery for the correction of myopia and myopic astigmatism appears to be very good and is related to the postoperative residual error. Although the majority of patients postoperatively experienced glare, particularly with driving at night, this was not related to the pupil-optical zone disparity or degree of correction.

Utility values and myopia in medical students in Singapore.

PURPOSE: Although technologies to correct myopia have progressed in recent years, it is not known how cost-effective such technologies are. In this paper, utility values of myopic medical students in Singapore were ascertained as a first step to deriving weights for quality adjustment in future cost-effectiveness studies of such technologies. METHODS: Students (n = 120) aged 18-22 years with myopia (spherical equivalent at least -0.5 D) from Singapore's sole medical school were recruited. Information on lifetime intention to undergo refractive surgery, contact lens use, proportion of waking time spent wearing corrective devices, and utility values using the time trade-off and standard gamble for death methods, were obtained. RESULTS: The mean utility values for time trade-off and standard gamble were 0.97 (95% confidence interval 0.96-0.98, median 1.00) and 0.99 (95% confidence interval 0.98-0.99, median 1.00), respectively. Utility values were significantly higher among those who reported a probability of less than 50% that they would undergo refractive surgery within their lifetime, compared with those who reported a probability of 50% or more (means 0.98 vs. 0.95, P < 0.001). CONCLUSION: Utility values in myopic medical students obtained in this study appear to be relatively high, compared with those obtained for other ophthalmic conditions.