Keratoconus and the Impact of Treatment on Patients' Quality of Life: A Qualitative Study.

INTRODUCTION: Keratoconus has a significant impact on patients' quality of life (QoL), from diagnosis to the advanced stages of the disease. The aim of this research was to identify domains of QoL affected by this disease and its treatment. METHODS: Phone interviews were conducted using a semi-structured interview guide, with patients with keratoconus stratified according to their current treatment. A board of keratoconus experts helped identify the guide's main themes. RESULTS: Thirty-five patients (rigid contact lenses, n = 9; cross-linking, n = 9; corneal ring implants, n = 8; and corneal transplantation, n = 9) were interviewed by qualitative researchers. Phone interviews revealed several QoL domains affected by the disease and its treatments: "psychological", "social life", "professional life", "financial costs" and "student life". All domains were impacted, independently of the treatment history. Few differences were found between treatment regimens and keratoconus stages. Qualitative analysis enabled the development of a conceptual framework based on Wilson and Cleary's model for patient outcomes common to all patients. This conceptual model describes the relationship between patients' characteristics, their symptoms, their environment, their functional visual impairment and the impact on their QoL. CONCLUSIONS: These qualitative findings supported the generation of a questionnaire to evaluate the impact of keratoconus and its treatment on patients' QoL. Cognitive debriefings confirmed its content validity. The questionnaire is applicable for all stages of keratoconus and treatments and may help tracking change over time in regular clinical settings. Psychometric validation is yet to be performed before its use in research and clinical practices.

Glistenings on intraocular lenses in healthy eyes: effects and associations.

PURPOSE: To assess glistenings in AcrySof (Alcon Laboratories Inc) intraocular lenses (IOLs), to quantify any effects of glistenings on the visual function of patients with healthy eyes, and to investigate whether glistenings were associated with demographic or lens characteristics. METHODS: Case files from a consecutive series of healthy eyes were retrospectively analyzed. Subjective glistening grades were investigated for associations with the following parameters: contrast sensitivity, corrected distance visual acuity (CDVA), intraocular light scattering (measured by C-Quant [Oculus Optikgeräte GmbH]), posterior capsule opacification, demographic characteristics, lens power, and duration of pseudophakia. The subjective grading method was compared to objective software-based quantitation of glistenings. RESULTS: The study cohort included 97 eyes from 65 patients with a mean age of 65 ± 11 years. Mean follow-up was 18 ± 17 months. Glistening grades did not vary by duration of pseudophakia (P=.19), although study design limited confidence in this result. Glistening grades had no associations with lens power (P=.41), intraocular light scattering (P=.31), logMAR CDVA (P=.64), contrast sensitivity at any spatial frequency (all P ≥.22), or with any other parameter under investigation. The software-based assessment confirmed the validity of the subjective grading method: glistening grades correlated with vacuoles/mm(2) (P<.0001) and mean values for vacuoles/mm(2) were statistically significant for each glistening grade (all P ≤.004). CONCLUSIONS: In healthy eyes, glistening grade was not associated with contrast sensitivity, CDVA, intraocular light scatter, or any lens or demographic characteristics that were investigated.

Glistening in glaucomatous eyes: visual performances and risk factors.

PURPOSE: To analyse risk factors and visual performances of glaucomatous eyes with glistening in the intra-ocular lens (IOL). METHODS: Prospective study performed between November 2010 and April 2011 and involving 67 consecutive glaucomatous eyes (47 patients), who previously had a phacoemulsification with a hydrophobic acrylic IOL implanted in the capsular bag. Glistening was classified in three groups of severity grade: G0 (<50 microvacuoles per mm(2) ), G1 (50-150 microvacuoles per mm(2) ), and G2 (>150 microvacuoles per mm(2) ). All eyes underwent a best-corrected visual acuity evaluation (BCVA, LogMAR scale), a complete clinical examination, a visual field test, a contrast sensitivity evaluation and a wavefront analysis of high-order aberrations (HOAs) using a Shack-Hartmann aberrometer. Eyes with a posterior capsular opacification and a BCVA>0.30 LogMAR were excluded. RESULTS: Twenty six eyes (38.8%) had a grade 0, 12 eyes (17.9%) a grade 1 and 29 eyes (43.3%) a grade 2 of glistening severity grade. The mean follow-up after cataract surgery was 35.2 ± 24.2 months and was significantly higher for G1 and G2 groups (p < 0.001). A higher number of topical glaucoma medication were associated with a higher glistening severity grade (p < 0.05). G1 and G2 groups had significantly lower mean contrast sensitivity values at high spatial frequencies and significantly higher loss variance (LV) values of the visual field test (p < 0.05). There was no significant difference in mean BCVA between groups (p = 0.455). CONCLUSIONS: In glaucomatous eyes, glistening increased with time was associated with the number of topical glaucoma medications daily instilled and altered visual performances. It should be a consideration for glaucoma patients who are more likely to develop glistening within the IOL optic.

Glistenings in a large series of hydrophobic acrylic intraocular lenses.

PURPOSE: To evaluate the incidence and severity of glistenings in hydrophobic acrylic intraocular lenses (IOLs) and assess the potential correlation between glistenings and clinical and demographic factors. SETTING: Service d'Ophtalmologie, Centre Hospitalier et Universitaire Bordeaux, Bordeaux, France. METHODS: Eligible patients received an AcrySof IOL between September 2000 and December 2007 and had a routine ophthalmic visit between January 2007 and March 2008. The incidence and severity of glistenings were graded subjectively and analyzed in relation to patient age and sex, length of follow-up, IOL model, IOL power, neodymium:YAG laser capsulotomy, corrected distance visual acuity (CDVA), spherical equivalent (SE), and selected ocular and systemic diseases and medications. RESULTS: Glistenings occurred in 157 (60.4%) of the 260 eyes; they were absent in 103 eyes (39.6%). Glistenings were of grade 1 severity in 87 eyes (33.5%) and of grade 2 severity in 70 eyes (26.9%). CONCLUSIONS: The results suggest a potential association between the incidence of glistenings and IOL power and glaucoma, but not between glistenings and age, sex, IOL model, length of follow-up, CDVA, SE, or most ocular and systemic diseases and medications.

COL4A1 mutation in Axenfeld-Rieger anomaly with leukoencephalopathy and stroke.

OBJECTIVE: Several hereditary ischemic small-vessel diseases of the brain have been reported during the last decade. Some of them have ophthalmological, mainly retinal, manifestations. Herein, we report on a family affected by vascular leukoencephalopathy and variable abnormalities of the anterior chamber of the eye. METHODS: After the occurrence of a small, deep infarct associated with white matter lesions in a patient with a medical history of congenital cataract and amblyopia, we conducted clinical and neuroradiological investigations in 10 of her relatives. RESULTS: Diffuse leukoencephalopathy associated with ocular malformations of the Axenfeld-Rieger type was observed in five individuals. Familial genetic analyses led to the identification of a novel missense mutation in the COL4A1 gene, p.G720D, which cosegregates with the disease. INTERPRETATION: Our data corroborate previous observations demonstrating the role of COL4A1 in cerebral microangiopathy and expand the phenotypic spectrum associated with mutations in this gene. We delineate a novel association between the Axenfeld-Rieger anomaly and leukoencephalopathy and stroke. Ann Neurol 2007.