EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/357599
EW CORNEA 34 by Maxine Lipner EyeWorld Senior Contributing Writer For example, in a patient who had hand-motion vision and is now reading the big letters on the chart, while that is an improvement, he was perhaps hoping for much more. The study emphasizes the impor- tance of having a frank discussion about expectations with patients. "I think it's important for the surgeon to get a good grasp on what [the patient's] current quality of life is before the surgery," she said. As for patient age, this is just one factor, she said. "I think the take-home message is that when it comes to corneal transplantation, in some ways you should treat age like a number and not use it as the full criteria in deciding who would benefit," Dr. Sikder said. EW Reference Puri S, Robinson SB, Wang J, Sikder S. Vision-related impact on quality of life in an elderly patient population after corneal transplantation. Cornea. 2014 Feb: 33(2)119–124. Editors' note: Dr. Sikder has no finan- cial interests related to her comments. Contact information Sikder: ssikder1@jhmi.edu to proceed. "Patients who had a higher baseline visual acuity did not demonstrate a significant change in their perceived quality of life, whereas those who had a lower baseline visual acuity thought that their quality of life was a little bit worse after the surgery." Managing expectations Dr. Sikder sees this as a great point about managing expectations. Those whose vision was worse prior to undergoing transplantation may be hoping for more after the surgery and therefore may feel a sense of dis- appointment, she said. Meanwhile, those who had higher vision going into the surgery may have had more realistic expectations. "I think that set the tone so they perceived an improvement in their quality of life after the surgery," she said. In considering the results, Dr. Sikder was surprised. "I assumed that if patients have poor vision, if you give them better vision they would be automatically appreciative of it, or at least feel that there is a differ- ence in the quality of their life," she said. "I think that point in partic- ular reinforced how it's important to have a candid discussion with patients about what they should expect." Discussion starting points When investigators looked at the results, they found several things that Dr. Sikder believes could be used as a starting point for a discus- sion with an elderly patient who might need a corneal transplant. "We found that patients who un- derwent partial-thickness transplan- tation, specifically DSAEK surgery, commented that their quality of life after surgery was better," Dr. Sikder said. She theorized that such patients did better with DSAEK be- cause of several factors. "One could speculate that with the less invasive surgery, the return to visual acuity (with DSAEK) is better or at least more prompt (than PK), so that may play a role," she said. In addition, investigators found that with older age came a positive relationship with perceived improve- ment in quality of life. This may be contrary to what some currently believe, Dr. Sikder said. "Sometimes we think that the patient who is at a more advanced age may not necessarily appreci- ate or fully embrace the potential change," she said, "but our data did show that the older the patients were, the more they commented on the improvement in quality of life." Dr. Sikder thinks this might be related to patients' perspective or might be an element of the duration of the disease. "If they have been putting up with a longer course of poor vision, it may be that the improvements they feel objectively or subjectively do make an improvement in their quality of life," she said. She stressed that the baseline quality of vision needs to be con- sidered when deciding whether How old is too old for corneal transplantation? I s it worth it to put an elderly patient through the rigors of a corneal transplantation proce- dure? A new study published in the February issue of Cornea indicates that indeed it is. In the recent study, older recipient age was positively associated with an improved quality of life, according to Shameema Sikder, MD, assistant professor of ophthalmology, Johns Hopkins University School of Medicine, and medical director, Wilmer Eye Institute, Bethesda, Md. The study grew out of a case of Dr. Sikder's involving an 80-year-old male patient with poor vision due to an infection. After engaging in a thorough discussion with the family, Dr. Sikder determined that despite the rigors of surgery, they would proceed with surgery for the patient to maximize his quality of life. After surgery, the patient did so well and was so enthusiastic that Dr. Sikder and her residents decided to do a study looking at the impact on quality of life for older patients undergoing corneal transplant. "I think there are assumptions among both patients and physi- cians about who would benefit the greatest from transplantation," Dr. Sikder said. In this retrospective, single- center study, investigators combed through the records of full- and partial-thickness transplant patients at the Wilmer Eye Institute, as well as those who had received a keratoprosthesis there. Age assessment August 2014 Investigators found that with older age came a positive relationship with perceived improvement in quality of life. This may be contrary to what some currently believe. Postop DSAEK Source: Mark Gorovoy, MD