Eyeworld

EW FEATURE 50 Patient satisfaction • December 2015 AT A GLANCE • Utilize patient experience tools that ask objective questions, such as use of artificial tears. • Valid conclusions require the capture of both subjective and objective measurements. • Complicated and second opinion cases may require use of wavefront analysis and aberrometry. • Integration of topography and ray tracing separates image quality impact of the cornea and tear film from that of the lens. by Rich Daly EyeWorld Contributing Writer may not appreciate the difference. For instance, in the WaveLight (Alcon, Fort Worth, Texas) FDA trial for wavefront-guided LASIK, Dr. Kezirian found that 63% of patients achieved 20/12.5 uncorrected vision and a similar number improved at least one line of BCVA, but patients rated their vision before surgery with glasses to be about the same as after surgery despite the improved objective measurements. "The patient's failure to appreci- ate the improvement does not imply the improvement is not experi- enced," Dr. Kezirian said. "Rather, the patient's failure to appreciate the improvement simply means they define a new 'normal' and adjust to what they have. For this reason, subjective reports must always be captured alongside objective mea- surements. Both sets of findings are needed to draw valid conclusions." Specifically, Dr. Alió selective- ly measures professional drivers undergoing refractive or cataract surgery to ensure that they can meet professional and regulatory require- ments. Stray light measurements are performed less frequently, while disability glare is more frequently performed because of strict require- ments on drivers. "We need to advise the patients whether or not they are going to have a limitation when it comes to these types of exams," Dr. Alió said. Dr. Lawless has found value and best uncorrected visual acuity, followed by contrast sensitivity function to measure visual function postop. Patient satisfaction is also analyzed by a short evaluation test. Similarly, Michael Lawless, MD, clinical associate professor, University of Sydney, and ophthal- mic surgeon, Vision Eye Institute, Sydney, Australia, uses Snellen acu- ity in routine cases, and in compli- cated cases he uses every subjective and objective test available to tease out subtleties in visual function and performance. "That way I get to truly under- stand the worth of new technologies and don't have to rely entirely on what's published by others," Dr. Lawless said. Subjective assessment The subjective success in patient satisfaction is a critical factor in surgeons' clinical outcome measure- ments. Dr. Alió requests anonymous patient feedback postop, provides a 10-question online survey, and ac- cepts the in-person feedback oppor- tunity preferred by older patients. As part of his effort to get happy patients after surgical treatment of any kind of refractive failure, Alois K. Dexl, MD, MSc, associate professor of ophthalmology, Para- celsus Medical University, Salzburg, Austria, uses subjective measure- ments, such as questionnaires, defocus curves, near visual acuity, or reading function. Such steps are needed to understand potential problems or why patients might be unsatisfied with the postop achieved results. "Subjective measurements will always be as necessary as objective measurements," Dr. Dexl said. Such patient-reported outcomes are very important, said Guy M. Kezirian, MD, president, SurgiVision Consultants, Scottsdale, Ariz., and patient sat- isfaction—regardless of the tech- nology—is the true determinant of surgical success. The subjective nature of patient experience has led Dr. Kezirian and colleagues to design surveys with subjective metrics that compare before and after findings and are quantifiable. "Purely subjective assessments are difficult to interpret," Dr. Kezirian said. "It is far more helpful to know whether the patient relies on artificial tears to address dry eye symptoms than it is to ask, 'Do your eyes ever feel dry?'" Multi-factor impacts Contrast sensitivity, stray light mea- surements, disability glare, mesopic acuity, and simulated night driving also factor into outcomes. Dr. Kezirian said that one of the unexpected epiphanies of previous clinical trials was that objective met- rics may improve but the patients Assessing objective, subjective clinical outcomes Monthly Pulse Patient satisfaction T he topic of this Monthly Pulse survey was "Patient satisfaction." We asked, "What do you think is the key factor to improve patient satisfaction?" A large majority of respondents to this survey said, "Outcomes that meet patients' expectations." To improve patient satisfaction in a prac- tice, most respondents to this survey would try to shorten the waiting time. "Use patient questionnaires" was the second most popular answer. We asked what source of information you think patients value the most, and more than half of respondents said, "Thoughtful discussion with the physician." When asked what they would consider recommending to a patient asking for spectacle indepen- dence after cataract surgery, most answered, "Try to assess patient's visual needs first." Finally, we asked, "For an unhappy premium IOL patient, what would you do first?" A large majority of respondents to this survey chose, "Analyze and discuss the patient's complaints." New tools provide more options for measuring both objective and subjective clinical outcomes A lthough subjective patient assessments of outcomes from refractive procedures remain the most import- ant factor for surgeons, they also need to use objective mea- sures to critically analyze outcomes from new technologies. Jorge Alió, MD, PhD, professor and chairman of ophthalmology, Miguel Hernandez University, and scientific director, Vissum Corp., Alicante, Spain, primarily relies on best corrected visual acuity (BCVA)

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