A questionnaire-based long-term follow-up of photorefractive keratectomy for low to high myopia

Poster Details

First Author: A.Vestergaard DENMARK

Co Author(s):    J. Hjortdal   A. Ivarsen   J. Grauslund   A. Sj     

Abstract Details

Purpose:

Although surgical techniques are rapidly evolving, surface ablation of the cornea is by many still considered the overall safest procedure for treatment of low myopia. Our purpose with this questionnaire-based study was to evaluate long-term patient satisfaction and patient reported visual disturbances up to 19 years after treatment of myopia with excimer laser photorefractive keratectomy (PRK).

Setting:

Department of Ophthalmology, Odense University Hospital, Denmark.

Methods:

Retrospective questionnaire-based study. In 2011, questionnaires were sent to a cohort of the first patients treated with PRK in Denmark. Patients had been treated at Odense University Hospital, Denmark, in the period 1992 to 1998. Before surgery, all patients had had stable myopia for one year and no other ocular diseases or conditions. The same surgeon had performed all surgical procedures with the same broad-beam laser (SVS Apex Laser system, Summit Technology, Inc.). Questionnaires were based on linear visual analogue scales from 0 to 10, anchored at each end by adjectival descriptors. Mean scores were calculated. Also, responses for questions were divided into 1 of 4 categories: very negative (0 to 2.5), negative (>2.5 to 5), positive (>5 to 7.5) and very positive (>7.5 to 10). No neutral responses were allowed in this categorisation. Patients were prior to surgery informed that there were no guaranties of spectacle independence, and that long-term side-effects were not known. This study was part of a retrospective follow-up study of the cohort, which also included a clinical eye examination. In total, 276 patients between 19 and 30 years (at the time of surgery) were invited.

Results:

Before surgery, mean spherical equivalent refraction was -4.85 ± 2.86 D, with 23% being highly myopic (more than -6.00 D). In total, 204 patients (74%) completed the questionnaire. Average follow-up time was 16 years and mean age was 42 years. In total of 45% needed distance visual correction, 21% needed near-vision correction, and 10% needed both. Concerning patient satisfaction, for patients without the need of glasses/contact lenses, the mean score was 9.0 ± 0.8 with 99% being satisfied or very satisfied. For patients with glasses mean score was 6.0 ± 2.9 and 65% were satisfied or very satisfied. Also, patients with low myopia were more satisfied than patients with high myopia. Concerning change in quality of life, mean score was 7.3 ± 2.5 and 89% felt an improvement in quality of life after PRK. Thirty-nine percent had problems or many problems with backlight glare, and 48% with nighttime glare. Eleven percent had problems or many problems with halos around light sources in daylight and 40% in nighttime. Also, 56% reported of problems or many problems with nighttime driving, with 23% reporting of problems and no or little improvement despite the use of glasses or contact lenses.

Conclusions:

This questionnaire-based long-term study demonstrates a high level of patient satisfaction up to 19 years after treatment of myopia with PRK, despite especially night time visual disturbances. Patient satisfaction was highly related to spectacle independence. Also, patients with high myopia were significantly less satisfied and had more visual disturbances than patients with low myopia. Thorough preoperative patient education is important to establish realistic expectations and satisfaction concerning overall outcome. FINANCIAL DISCLOSURE?: No