Patient-Reported Outcomes After Corneal Transplantation.

PURPOSE: To characterize vision-related quality of life after penetrating keratoplasty (PKP), deep anterior lamellar keratoplasty (DALK), Descemet stripping automated endothelial keratoplasty (DSAEK), and Descemet membrane endothelial keratoplasty (DMEK) using the National Eye Institute Visual Function Questionnaire (NEI-VFQ 9). METHODS: Using the Sight Outcomes Research Collaborative ophthalmology electronic health record repository, questionnaire responses were obtained from 103 PKP patients, 24 DALK patients, 42 DSAEK patients, and 50 DMEK patients undergoing postoperative examination. No exclusions were made based on preoperative diagnosis, age, complications, or comorbidities. Associations between clinical characteristics and vision-related quality of life were analyzed using nonparametric and linear regression methods. RESULTS: Patients were surveyed an average of 1.5 years postoperatively (range 24 d to 4.4 yrs). Participants who had undergone DALK, DMEK, DSAEK, and PKP had median composite VFQ scores of 77.8, 84.2, 76.1, and 70.6, respectively (P= 0.002). There were no significant differences in VFQ scores between patients treated with DMEK versus DSAEK (P = 0.440) or between patients treated with PKP versus DALK (P = 1.000). Higher postoperative acuities in the operative and fellow eyes were associated with higher VFQ scores (P < 0.001 and P < 0.001). When controlling for postoperative acuity by regression modeling, surgery type was not associated with patient-reported composite VFQ scores. CONCLUSIONS: In this study, patient-reported vision-related quality of life was similar among DMEK and DSAEK participants and also among DALK and PKP participants. When controlling for postoperative acuity, vision-related quality of life was similar among all study participants, irrespective of the keratoplasty technique.

Patient-Reported Vision-Related Quality of Life After Boston Type I Keratoprosthesis.

PURPOSE: To determine patient-reported vision-related quality of life (VR-QoL) after Boston type I keratoprosthesis (BKPro) and its determinants. METHODS: A cross-sectional study including consecutive consenting BKPro patients was conducted. The French National Eye Institute Visual Function Questionnaire-25 measured postoperative VR-QoL. Medical charts were retrospectively reviewed for demographics, ocular comorbidities, indication for surgery, postoperative visual acuity (VA), and complications. Univariate analyses were used to identify VR-QoL determinants. Multivariate linear regression was additionally performed for patients operated unilaterally, using VR-QoL as the dependent variable and age, sex, and postoperative VA as covariates. P < 0.05 indicated statistical significance. RESULTS: Sixty-three patients, aged 63 ± 13 years, with a mean follow-up of 54 ± 19 months, were included. VR-QoL was measured 53 ± 18 months postoperatively. "Composite" VR-QoL scores in patients with unilateral (n = 51) and bilateral (n = 12) BKPro were 65 ± 23 and 63 ± 19, respectively, and did not significantly differ between the 2 groups (P = 0.71). In patients with unilateral BKPro, VR-QoL was determined by postoperative VA in the better eye, which was the contralateral nonoperated eye in most cases. Achieved vision in the operated eye contributed to VR-QoL when vision in the contralateral nonoperated eye was poorer. In the bilateral BKPro group, VR-QoL was determined by postoperative VA in the better eye and the number of ongoing complications. CONCLUSIONS: Five-year VR-QoL scores were lower in BKPro patients compared with healthy cohorts reported in the literature and were similar after unilateral and bilateral BKPro surgery. The main determinant of postoperative VR-QoL was postoperative vision in the better eye.

Impact of type I Boston keratoprosthesis implantation on vision-related quality of life.

AIM: To determine the impact of type I Boston keratoprosthesis (KPro) implantation on vision-related quality of life (VRQoL). METHODS: Prospective study in 33 patients (mean age 56±12 years, 67% male) with bilateral corneal blindness, who underwent a KPro implantation at a single tertiary eye hospital (June 2011-July 2015). VRQoL was evaluated using the Impact of Vision Impairment Questionnaire (IVI) at baseline and at 3-6 months postsurgery, after stabilisation of best-corrected visual acuity (BCVA). Rasch analysis was used to transform the IVI responses into interval-level measures comprising the 'reading', 'mobility' and 'emotional' subscales with effect sizes calculated for pre-post VRQoL scores. RESULTS: Mean preoperative BCVA was counting-fingers at 2 feet in the operated eye (20/240 fellow eye). Preoperative VRQoL scores: -2.27, -2.91 and -3.06 logits for the reading, mobility and emotional subscales, respectively. Device retention rate was 90% over the follow-up period (mean 26±12 months). We observed large gains for reading and mobility of 1.92 logits (effect size 0.88), and 2.64 logits (effect size 0.89) respectively, with a moderate gain in the emotional subscale of 2.11 logits (effect size 0.59). These improvements did not vary significantly with BCVA on multivariate analysis (all p>0.05). CONCLUSION: We observed a differential short-term improvement to VRQoL after KPro implantation with a significant impact on emotional well-being, which may not be fully explained by visual improvement alone. Further studies are required to confirm if these improvements in VRQoL are sustained in the long-term and are generalisable to other populations.

Vision-Related Quality of Life Before and After Deep Anterior Lamellar Keratoplasty.

OBJECTIVES: To determine changes in the vision-related quality of life in patients undergoing deep anterior lamellar keratoplasty (DALK) by using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). METHODS: Thirty-five patients who were scheduled for DALK between March 1, 2013, and March 1, 2014 were asked to complete the NEI VFQ-25. NEI VFQ-25 was administered again at 6 months and at 1 year postoperatively. Data on patients' age, sex, preoperative diagnosis, preoperative and postoperative best-corrected visual acuity, and postoperative astigmatism were recorded. RESULTS: Successful DALK with the Anwar big bubble technique was achieved in 23 of 35 (65.7%) patients. The indications for surgery were keratoconus in 15 patients (62.2%), stromal corneal dystrophies in 4 (17%), and corneal scar in 4 (17%). The mean preoperative NEI VFQ-25 composite score (55.2±19.7) improved significantly (76.9±11.6) at 6 months after DALK and continued to improve (84.3±6.6) at 1 year postoperatively (Friedman test, P=0.001). All NEI VFQ-25 subscale item scores increased significantly after surgery. The patients' age was significantly correlated with the NEI VFQ-25 subscale score of mental health at 6 month and at 1 year postoperatively (r=0.92, P=0.008 and r=0.94, P=0.005, respectively). There was a negative relationship between postoperative astigmatism at 1 year and NEI VFQ-25 ocular pain, social functioning, peripheral vision, and mental health subscale scores (r=-0.76, P=-0.07; r=-0.53, P=0.2; r=-0.53, P=0.27; r=-0.80, P=0.05). CONCLUSION: Vision-related quality of life improved significantly after DALK and continued to improve after suture removal.

Quality of life and handling experience with the PROSE device: an Indian scenario.

BACKGROUND: PROSE (prosthetic replacement of ocular surface ecosystem) device is a custom-designed, corneal vaulting scleral contact lens, which is used in the treatment of irregular corneal conditions to improve vision and comfort. The present study aimed at assessing the success of the PROSE device in an Indian scenario in terms of change in quality of life and to understand the handling issues related to the device use. METHODS: Thirty-two subjects with various irregular corneal conditions meeting the inclusion criteria were included in the study. Subjects were followed for three months after dispensing the PROSE device. Subjects' demographic details, high and low contrast visual acuity with habitual correction and PROSE device, Visual Function Questionnaire scores (NEI VFQ-25) and Ocular Surface Disease Index (OSDI) scores pre- and post-PROSE treatment were collected and compared. An indigenously developed questionnaire was also administered during the follow-up visit for assessing the handling-related issues faced by the subjects while using the device. RESULTS: Forty eyes of 32 subjects were included in the study, of whom 30 reported for follow-up. The median NEI VFQ-25 score improved from 47.33 points to 77.27 points over a period of three months, which was statistically significant (p < 0.05). There was a statistically significant decrease in median OSDI score from 51.14 points to 13.63 points post-PROSE treatment (p < 0.05). Subjects reported no or very minimal handling-related difficulties associated with the use of the PROSE device. CONCLUSION: The PROSE treatment can be an effective mode of managing patients with irregular corneal conditions and significantly improved the vision-related quality of life of patients suffering from these conditions. The handling of the device is easy and can be mastered with adequate training.

Quality of Life and Mental State After Sight Restoration by Corneal Transplantation.

BACKGROUND: Quality of life has frequently been reported to improve after corneal transplantation. However, mental status before and after surgery has until now been less well investigated. OBJECTIVE: The aim of this study was to investigate quality of life and mental status before and after corneal transplantation including postoperative immunosuppression and visual acuity. METHODS: A total of 45 patients were assessed before, and 3 weeks and 4 months after transplantation using the following questionnaires: Visual Function Questionnaire, Beck Depression Inventory, and Hamilton Anxiety Rating Scale. Assessment included a visual acuity test using the logMAR chart, and recognition of the role of postoperative immunosuppression. Finally, patients were asked if they would be willing to have the surgery again. RESULTS: In the candidates for surgery, quality of life was reduced, and symptoms of depression and anxiety were present. Corneal transplantation improved their quality of life and reduced symptoms of depression and anxiety. Changes in quality of life and in mental state were associated with a change in visual acuity in the grafted eye. Higher doses of prednisone were associated with a worse quality of life and with more severe symptoms of depression and anxiety after transplantation. Further, 82.5% of patients would have the surgery again. CONCLUSION: Assessment for psychiatric symptoms should be considered in individuals facing corneal surgery.

Population-based assessment of vision-related quality of life in corneal disease: results from the CORE study.

OBJECTIVE: To assess the impact of corneal disease on vision-related quality of life (VR-QoL) in a rural North Indian population. DESIGN: Cross-sectional, population-based study. METHODS: The Corneal Opacity Rural Epidemiological (CORE) study included 12 899 participants from 25 randomly selected clusters of rural Gurgaon, Haryana, India, with the primary objective of determining the prevalence of corneal disease in the general population during July 2011 to January 2013. VR-QoL was assessed through Indian Vision Function questionnaire (IND-VFQ-33) in adult participants (aged ≥18 years) detected with corneal opacity and equal number of healthy controls (no ocular pathology with visual acuity of 6/6 binocularly) selected from the same clusters. Scores of the three subscales of IND-VFQ-33 (vision-specific mobility, psychosocial impact and visual symptoms) were computed, analysed and compared separately across various groups. RESULTS: Overall, 12 113 participants of all ages underwent detailed ophthalmic examination and VR-QoL was assessed in 435 cases with corneal disease and 435 controls without any ophthalmic disease. The diseased population had significantly higher scores and hence poorer VR-QoL across all three domains of vision function (scores of 28 vs 22; 6 vs 5 and 14 vs 9, respectively; p<0.0001) and the scores were inversely related with the level of visual impairment in patients with corneal disease. Patients with unilateral corneal disease also had poorer VR-QoL scores as compared with healthy controls (p<0.0001). CONCLUSIONS: VR-QoL is impaired in patients with corneal disease, more so in patients with corneal blindness. This is the first population-based study to document VR-QoL through IND-VFQ-33 in the Indian population with corneal disease.

Vision-Related Quality of Life in Patients with Ocular Graft-versus-Host Disease.

PURPOSE: To assess the vision-related quality of life (QOL) in a cohort of patients with ocular graft-versus-host disease (GVHD). DESIGN: Prospective study. PARTICIPANTS: Eighty-four patients diagnosed with chronic ocular GVHD. METHODS: We assessed the vision-related QOL with the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). The symptoms of ocular GVHD were assessed using the Ocular Surface Disease Index (OSDI) and Symptom Assessment in Dry Eye (SANDE) questionnaires. MAIN OUTCOME MEASURES: We assessed vision-related QOL with the NEI-VFQ-25 and compared the scores obtained from patients with ocular GVHD with those from a healthy population. In the ocular GVHD population, we also evaluated the associations between the NEI-VFQ-25 and the dry eye symptoms measured by the OSDI and SANDE questionnaires, age, duration of disease, best-corrected visual acuity (BCVA), corneal fluorescein staining (CFS), tear break-up time, and Schirmer test. RESULTS: The mean composite NEI-VFQ-25 score in patients with ocular GVHD was 76.5±17. Compared with healthy subjects, patients with ocular GVHD reported reduced scores on all NEI-VFQ-25 subscales (each P < 0.001) with the exception of color vision (P = 0.11). The NEI-VFQ-25 composite scores significantly correlated with OSDI (R = -0.81, P < 0.001), SANDE (R = -0.56, P < 0.001), CFS (R = -0.36, P = 0.001), and BCVA (R = -0.30, P = 0.004). CONCLUSIONS: Patients with ocular GVHD experience measurable impairment of vision-related QOL. This study highlights the impact of ocular GVHD on the vision-related QOL, and thus the importance of comprehensive diagnosis and treatment of this condition.

Vision-related quality-of-life assessment using NEI VFQ-25 in patients after Boston keratoprosthesis implantation.

PURPOSE: The aim of this study was to determine the impact of Boston keratoprosthesis (KPro) implantation on patient-reported visual function using the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25). METHODS: This is a prospective study of patients undergoing implantation of Boston KPro. The NEI VFQ-25 was used to assess vision-related quality of life preoperatively and postoperatively at 3 and 6 months and yearly thereafter. Baseline scores were compared with postoperative scores using paired t test. Stratified analysis was performed to compare results by visual acuity of the contralateral eye. RESULTS: Twenty-four patients were included. Mean baseline NEI VFQ-25 overall score was 44.6. At the first follow-up time point, mean overall score was 70.0, representing a statistically significant change from baseline (P < 0.001). Breakdown of subcategories within VFQ-25 showed significant improvement in general vision, near and distance activities, social functioning, mental health, role difficulties, dependency, color vision, and peripheral vision (P < 0.05). This improvement was also observed when comparing baseline scores with postoperative scores at average follow-up of 16 months. Although a greater change in scores was observed in patients who had poor vision in the contralateral eye, patients with vision better than 20/200 in the nonsurgical eye showed statistically significant improvement in overall scores and subscale scores compared with baseline. CONCLUSIONS: The quality of life of patients who underwent KPro significantly improved postoperatively compared with their preoperative status. These results did not change when stratifying by visual acuity of the contralateral eye.

Ocular manifestations of transconjunctival heroin abuse: a case report of an unusual route of substance abuse.

PURPOSE: The purpose of this study was to present a patient with atypical corneoconjunctival lesions as a result of transconjunctival heroin abuse. METHODS: The authors conducted a prospective 8-month follow up of a 16-year-old girl who presented with bilateral atypical corneoconjunctival lesions. RESULTS: After a period of close observation, running diagnostic tests, and conservative treatment, the nature of the disease was suspected. Further discussion with the patient's family and her final confession revealed that she was using heroin through the conjunctiva. CONCLUSION: Substance abuse should be considered in the list of differential diagnoses in patients with an unusual presentation of ocular disease.

Abnormal rubbing and keratectasia.

PURPOSE: Hypotheses for the varied pathogenesis of the different forms of keratoconus have been outlined. Against this background, the possibility that abnormal rubbing causes or contributes to the development or progression of some forms of keratoconus has been examined. METHODS: Circumstantial evidence that shows an association between abnormal rubbing and keratoconus is reviewed, and a wide range of different forms of abnormal rubbing is described. Also examined is evidence of several processes whereby the cornea appears to be, or could be, adversely affected by mechanical trauma caused by rubbing. Conditions that may increase susceptibility to mechanical rubbing trauma have been discussed. RESULTS: Evidence of a role for inflammatory mediators in the pathogenesis of keratoconus appears to void the description of keratoconus as a noninflammatory condition. When vigorous knuckle-rubbing forces are located on the normal peripheral cornea, the thinner or weakened cone apex may be exposed to high intraocular pressure distending forces that may tend to promote ectasia. CONCLUSIONS: It appears reasonable to conclude that abnormal rubbing is a cause of some types of keratoconus, not because all abnormal rubbing, or only abnormal rubbing, leads to the development of some types of keratoconus, but because abnormal rubbing may increase the likelihood of the development of some forms of keratoconus. Abnormal rubbing habits may commence or continue after routine contact lens wear is established. Any associated rubbing or contact lens trauma may contribute to the progression of keratoconus. The abnormal rubbing-ectasia association in keratoconus may extend to other forms of keratectasia, including that seen after laser in situ keratomileusis, for which a contributory abnormal rubbing hypothesis may be appropriate.