EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/119916
March 2013 EW RESIDENTS 65 EyeWorld journal club Review of "A correlation of visual quality with satisfaction and function in a normal cohort of pseudophakic patients" by Zaina Al-Mohtaseb, MD, Lena Dixit, MD, Beeran Meghpara, MD, Caroline Schmidt, MD, and Mitchell P. Weikert, MD, residency program director, Cullen Eye Institute, Baylor College of Medicine, Houston Mitchell P. Weikert, MD Residency program director, Cullen Eye Institute, Baylor College of Medicine, Houston This paper reports on a study first presented by Randall Olson, MD, in his 2012 Binkhorst Lecture. This month's journal club review is provided by the Baylor residents. David F. Chang, MD, chief medical editor T he authors of this paper addressed the great challenge of understanding the "unhappy 20/20 patient" after uncomplicated cataract surgery. Given the large number of cataract surgeries performed worldwide and the progressive increase in patient expectations, it is important to analyze patient satisfaction and visual function in the postoperative setting. This paper attempts to determine the etiology of patient dissatisfaction following cataract surgery. Previous studies have attempted to characterize dissatisfaction in pseudophakic patients by comparing their complaints to age-matched phakic patients, but unfortunately, these studies have failed to eliminate key confounding variables, such as A correlation of visual quality with satisfaction and function in a normal cohort of pseudophakic patients Krista Kinard, MD, Allison Jarstad, BS, Randall J. Olson, MD J Cataract Refract Surg (April) 2013; 39:590-597 Purpose: To select a normal post-cataract surgery cohort, determine visual quality parameters, and compare these parameters with self-reported satisfaction and visual function. Setting: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah. Design: Retrospective cohort study. Methods: A cohort of pseudophakic patients was selected based on uneventful surgery, good corrected visual acuity (no worse than logMAR 0.02), and lack of ocular complaints or pathology including dry eye syndrome or posterior capsule opacification. A single-piece high-refractiveindex acrylic intraocular lens, age 50 or older, and at least 1 year out from surgery were other inclusion criteria. Testing included logMAR corrected distance visual acuity (CDVA), mesopic 10% contrast logMAR CDVA with and without glare, stray light determination, Rasch-modified National Eye Institute Visual Function questionnaire 11R (NEI VF-11R), custom pseudophakic dysphotopsia survey, and overall satisfaction question. Correlations were determined between these parameters. Results: Of the 2,953 patients considered, 70 patients met all criteria, provided consent, and enrolled. Only pseudophakic dysphotopsia (r=−0.60; P<.0001) and the NEI VF-11R (r =−0.44; P<.0001) correlated with overall satisfaction. In addition, pseudophakic dysphotopsia correlated with the NEI VF-11R (r=0.58; P<.0001). Conclusions: When evaluating a highly controlled population with expected high satisfaction after cataract surgery, pseudophakic dysphotopsia was clearly the only significant dissatisfier. Furthermore, dysphotopsia highly correlated with the NEI VF-11R questionnaire; thus, symptoms of dysphotopsia are also seen to have functional significance. A shortened NEI VFQ survey and satisfaction correlated strongly with the full survey. Financial disclosure: Dr. Olson has financial interests with Abbott Medical Optics, Becton, Dickinson and Co., and Allergan. No author has a financial or proprietary interest in any material or method mentioned. Back row: Beeran Meghpara, MD, Zaina Al-Mohtaseb, MD, Caroline Schmidt, MD; seated: Lena Dixit, MD Source: Mitchell P. Weikert, MD dry eye, posterior capsular opacification, and macular pathology, which likely impacted the validity of their outcomes. This study, which is a retrospective cohort of uncomplicated postoperative cataract patients, had strict inclusion and exclusion criteria to eliminate possible confounding variables. The cohort was surveyed to determine three main attributes: visual function, overall satisfaction, and dissatisfaction specifically related to positive dysphotopsias. The authors used the standardized NEI Visual Function Questionnaire (NEI VFQ) to assess visual function and a one-question survey to gauge overall satisfaction. They also developed a new questionnaire, the Positive Dysphotopsia Questionnaire (PDQ), to assess symptoms of positive dysphotopsias. In this highly controlled population of pseudophakic patients, the authors found that although both visual function and positive dysphotopsias independently correlated with patient satisfaction, the presence of positive dysphotopsias remained the only factor with a statistically significant correlation. Visual acuity parameters, such as refractive error and astigmatism, did not correlate with visual function or satisfaction. In addition, there was a strong correlation between visual function (NEI VFQ) and positive dysphotopsias (PDQ), which suggests that positive dysphotopsias affect important visual functions outlined in the NEI survey. From these results, the authors deduced that positive dysphotopsias are the primary source of patient dissatisfaction after uncomplicated cataract surgery. Although positive dysphotopsias did correlate with visual function and overall satisfaction, one cannot infer that they exclusively contribute to these outcomes because alternative surveys for other potential subjective complaints were not given. For example, a survey about subjective dry eye symptoms may have also correlated with visual function and overall satisfaction. Thus, one cannot accurately conclude that positive dysphotopsias are the leading correlator to satisfaction and function in these postoperative patients until other subjective parameters are explored. Some of the strengths and weaknesses of this study relate to its retrospective nature. A major strength of this study is its design as a retrospective cohort, which allowed the authors to evaluate a highly controlled population of uncomplicated continued on page 66