Patient Reported Outcomes in Microbial Keratitis.

PURPOSE: The aim of this investigation was to study the patient-reported outcomes of patients with microbial keratitis (MK) using the 9-item National Eye Institute-Visual Function Questionnaire (NEI VFQ-9). METHODS: Using the Sight Outcomes Research Collaborative ophthalmology electronic health record repository, patients with MK and control patients who completed the NEI VFQ-9 within 7 days of their appointment were identified. The questionnaire is scored as a mean of the 9 items on a scale from 0 to 100, with higher scores indicating better functioning. Composite and individual item scores were compared between groups using the analysis of variance. RESULTS: In total, 916 questionnaires were completed from patients with acute MK (n = 84), nonacute MK (n = 30), MK with a corneal transplant (n = 21), from controls seen in a satellite comprehensive ophthalmology clinic (n = 528), and controls seen at a subspecialty ophthalmology clinic (n = 253). The mean NEI VFQ-9 composite scores per group were 66.6 (SD = 26.8), 78.1 (SD = 17.1), 58.6 (SD =21.6), 88.0 (SD = 10.2), and 83.5 (SD = 13.0), respectively (P < 0.0001). Both patients with acute MK and patients with MK requiring transplant reported significantly worse function than nonacute MK, comprehensive, and specialty patients. Patients with nonacute MK reported significantly worse function than comprehensive control patients (all Tukey-adjusted P < 0.05). DISCUSSION: Patients who had or eventually require corneal transplant for management of their MK report worse visual function than patients with nonacute MK. This may be important in helping physicians counsel their patients.

Vision-related quality of life in patients with infectious keratitis.

PURPOSE: To determine the vision-related quality of life (VR-QOL) in patients with infectious keratitis using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). METHODS: Sixty-five patients with infectious keratitis (IK) were enrolled in the study. The NEI VFQ-25 scores and clinical and demographic data, including age, gender, pathogen, best corrected visual acuity (BCVA), and duration of the disease, were collected from the subjects. The subscale and composite scores were calculated and analyzed. Correlations between the VFQ-25 scores and the clinical and demographic features were also explored. RESULTS: The mean age of enrolled subjects was 48.4 years (SD, 16.2), with 44 males (67.7%). The microbial pathogens were viruses (n = 48, 73.8%), fungi (n = 13, 20.0%), and bacteria (n = 4, 6.2%). The mean scores of each VFQ-25 subscale ranged from 31.9 (SD, 28.6) for role difficulties to 92.7 (SD, 13.1) for color vision; the mean composite score was 58.1 (SD, 19.2). Significant differences in scores were observed only in the subscale of dependency among educational levels and in the mental health subscale and the composite among the three pathogen groups. Multivariate regression analysis revealed that VFQ-25 composite score correlated significantly with the BCVA of the worse-seeing eye, duration of the disease, history of operation (for IK treatment), and gender. CONCLUSIONS: Infectious keratitis has extensive impacts on patients and VR-QOL. The BCVA of worse-seeing eye, duration, history of operation for IK treatment, and gender contributed independently to VR-QOL. Early treatment should be encouraged to obtain better visual prognosis and VR-QOL for patients with IK.

Health belief and health practice in contact lens wear--a dichotomy?

PURPOSE: To establish if the hygiene practice of contact lens wearers (CLWs) can be influenced by "health belief." METHODS: A nested case-control study based on questionnaires was conducted in Hong Kong over a 17-month period between 45 CLW patients with microbial keratitis and 135 matched asymptomatic CLW volunteer controls. RESULTS: There was no significant difference between keratitis patients and controls (volunteers) in the perceived benefits of optometrists' instructions generally. When asked specifically, however, keratitis patients scored significantly higher than controls in the perceived benefit of checking initially with the optometrist for the correct method of lens cleaning. Contact lens wearing patients with keratitis were confident that their care of lenses would prevent complications, but this probably represented over confidence in themselves. Patients also scored significantly more neutrally in self-efficacy. Surprisingly, patients were significantly less likely to perceive the cost of lens care as a barrier but did not use their disinfecting regimes properly. CONCLUSION: We have found that CLWs still regard their eye care professional as being the most important for giving them advice on hygiene. There is considerable opportunity to educate and influence CLWs in ways to prevent infection, but the advice given must be correct. Continuing education of optometrists is also required.