Patient satisfaction with refractive error correction important

Key Points

Fort Lauderdale, FL-Refractive error is the leading cause of visual impairment in the world, and it is important that clinicians assess patient satisfaction and quality of life involving any effort to address refractive error, said George O. Waring III, MD. He made his remarks in a lecture after receiving the Mildred Weisenfeld Award for Excellence in Ophthalmology here at the Association for Research in Vision and Ophthalmology annual meeting.

Refractive error affects 30% to 70% of the population, or 153 million people, according to the World Health Organization (WHO), said Dr. Waring, clinical professor of ophthalmology, Emory University, Atlanta. In comparison, he added, WHO estimates that 124 million people have low vision and 37 million are blind.

Glasses, contacts, and IOLs are the most common prosthetic devices used to address refractive errors, said Dr. Waring. Cataract surgery is the top operation in humans in the Western world in terms of volume, he added.

"At the time [1981 to 1995], this was the first attempt to get a scientific, subjective questionnaire to evaluate refractive surgery patients," he said.

The researchers measured patient satisfaction via 10 questions that were part of a lengthier psychometric questionnaire. Patients had –2.00 to –8.00 D of myopia and at the time of assessment had undergone surgery on only one eye. In 1986 in Archives of Ophthalmology, the investigators reported that 48% of patients said they were very satisfied, 42% reported being moderately satisfied, and 10% were dissatisfied. The three main reasons that patients expressed dissatisfaction were uncorrected visual acuity, residual refractive error, and subjective daily fluctuation in vision. A multiple regression analysis including these three variables, glare, and patient gender was able to predict 46% of the variance in patient satisfaction.

Satisfaction with surgery

More recently, several efforts have been or are being undertaken to assess patient satisfaction with refractive surgery, including LASIK, Dr. Waring said. The six-item Vision Quality of Life Index (VisQoL) and the 20-item Quality of Life Impact of Refractive Correction (QIRC) questionnaire have found that patients who undergo refractive surgery are more satisfied with their quality of life than are those who wear contact lenses or glasses, he said.

In a cross-sectional study of the VisQoL instrument published in Investigative Ophthalmology and Visual Science in 2005, quality of life was compared in 64 adults with emmetropia, 66 adults with myopia who had undergone refractive surgery, and 65 adults with myopia who wore spectacles and/or contact lenses. Researchers did not find significant differences between the refractive surgery and emmetropia groups, but members of the spectacles/contact lenses group demonstrated significantly greater odds of having concerns about injuring themselves, coping with the demands of life, and fulfilling roles, and they reported less confidence in participating in everyday activities compared with those who had emmetropia.

In a study published in 2006 in the Journal of Refractive Surgery using the previously validated QIRC questionnaire, the instrument was administered to 312 patients equally divided among those who had undergone refractive surgery, those who wore contact lenses, and those who wore spectacles. On a scale of 0 to 100 with 100 representing the highest level of satisfaction, refractive surgery patients had a mean QIRC score of 50.2, contact lens wearers had a mean score of 46.7, and spectacle wearers had a mean score of 44.1. (Ophthalmologists and others may obtain additional information about the QIRC questionnaire, including the questionnaire itself for use in their practices, at http://www.pesudovs.com/konrad/QIRC.html.)