Personality influences visual quality of life post-LASIK

Key Points

San Diego-Initial results from a subset of a larger study designed to evaluate the role of personality and psychiatric factors on patient satisfaction and quality of life after LASIK indicate that personality has a significant influence on visual quality of life, said Jennifer Morse, MD. Dr. Morse and her collaborators, Capt. (retired) Steven C. Schallhorn, MD, and David J. Tanzer, MD, are analyzing the remaining data collected from extensive pre- and postoperative questionnaires administered to 309 consecutive subjects who underwent bilateral conventional LASIK at the Naval Medical Center, San Diego (NMCSD).

"With this research, our goal is to develop customized clinical assessment tools that will guide surgeons and their staff to be more effective in their preoperative and postoperative screening, communication, and counseling of refractive surgery patients," said Dr. Morse, retired chairman of psychiatry at NMCSD.

"In the meantime, our initial analyses suggest that refractive surgeons should include an objective evaluation of personality factors in their preoperative screening. Objective is the key, because the personality or day-to-day stress level of the refractive surgeon or clinic staff can confound the ability to identify potentially problematic patients accurately," she continued.

The research that Dr. Morse discussed was initiated by recognition of the fact that some refractive surgery patients express great dissatisfaction and emotional distress, sometimes despite good results, whereas other patients seem to have a much more difficult time coping with the outcomes of their surgeries than might be expected.

Patients' post-LASIK dissatisfaction can have a disruptive impact on an ophthalmology practice, particularly when surgeons and staff are not prepared to communicate effectively with such patients.

"The majority of patients are highly satisfied after LASIK, but there is a certain subset that is very unhappy, and they can be very vocal with their complaints. Those patients are the people who take up extra time in the chair and with the front office staff, who may be out in the community and on the Internet complaining about their experience, and who may go on to file malpractice lawsuits," Dr. Morse said.

Patient surveys

The 309 patients included in the study were treated for mild-to-moderate myopia with up to 3 D of astigmatism. The population had a mean age of 36 years and was composed predominantly of men (79%).

All patients completed the validated Armstrong Laboratory Personality Survey (ALPS) preoperatively and a quality of life questionnaire both before and 1 month after surgery. The ALPS is a 240-item survey that includes personality, psychopathology, and interpersonal subscales. It has been analyzed extensively to define a "personality index score." The results of the survey for this study population showed that it had a normal distribution of personality traits.

The quality-of-life questionnaire includes 40 items and evaluates visual quality of life, regret, nonvision-correction eye complaints, physical appearance, and self-esteem. The visual quality-of-life section composed eight questions that were derived partly from work with focus groups; the questions relate to overall vision and vision for hobbies, work, and near tasks. Patients respond using a scale of 1 to 10 where 1 represents the best response and 10 the worst.

Factor 1: postoperative UCVA

The results from the postoperative visual quality of life questionnaire showed that 88% of the patients in the study had an average score of 1 to 3 and were considered highly satisfied after LASIK. Only 2% of patients had average scores of 8 or higher and were considered highly dissatisfied.

A multivariate regression analysis was conducted to examine associations between age, gender, low-light pupil diameter, pre- and postoperative refractive error, contrast sensitivity, postoperative uncorrected visual acuity (UCVA), and the personality index on visual quality of life. Only three of those factors were significant. In descending order of importance, they were postoperative UCVA, personality index, and age. The three factors together explained a reasonable amount of the variance (37%), Dr. Morse said.

"The finding that UCVA played the largest role was expected and the importance of age is not surprising considering that we included some questions that addressed near vision. Therefore, age may reflect presbyopia," she commented.

Dr. Morse observed that suboptimal UCVA can usually be addressed with re-treatment or a prescription for glasses or contact lenses. Although surgeons have no control over age, understanding of its role is important because it can help identify patients who should receive additional preoperative counseling.

"Similarly, the personality factor is something that refractive surgeons can't influence. If it is identified preoperatively and you decide to proceed with the surgery, however, you can be prepared to counsel these patients more intensively pre- and postsurgery and try to adapt your communications with them based on their personality style," Dr. Morse said.