National Eye Institute Refractive Error Research Articles

Assessment of the Psychometric Properties of a Questionnaire Assessing Patient-Reported Outcomes With Laser In Situ Keratomileusis (PROWL)

Patient-reported outcome (PRO) measures for laser in situ keratomileusis (LASIK) are needed. To develop PRO measures to assess satisfaction, eye-related symptoms, and their effect on functioning and well-being following LASIK based on patient and expert input. The Patient-Reported Outcomes With LASIK (PROWL) studies were prospective observational studies of patients undergoing LASIK surgery for myopia, hyperopia, or astigmatism. PROWL-1 was a single-center study of active-duty US Navy personnel and PROWL-2 was a 5-center study of civilians. PROWL-1 enrolled 262 active-duty service personnel and PROWL-2 enrolled 312 civilians 21 years or older who spoke English; 241 individuals in PROWL-1 and 280 in PROWL-2 completed a baseline questionnaire before surgery. The analytic sample included those also completing 1 or more follow-up questionnaires: 240 (99.6%) of those in PROWL-1 and 271 (94.4%) of those in PROWL-2. Questionnaires were self-administered through the internet preoperatively and at 1 and 3 months postoperatively in both studies and at 6 months postoperatively in PROWL-1. PROWL-1 began in August 2011 and was completed May 30, 2014; PROWL-2 began in July 2012 and was completed June 27, 2014. Data were analyzed from June 28, 2014, to October 24, 2016. Scales assessing visual symptoms (double images, glare, halos, and starbursts), dry eye symptoms, satisfaction with vision, and satisfaction with LASIK surgery. Items from the National Eye Institute (NEI) Refractive Error Quality of Life Instrument (NEI-RQL-42), NEI Visual Function Questionnaire (NEI-VFQ), and the Ocular Surface Disease Index (OSDI) were included. All scales are scored on a 0 to 100 possible range. Construct validity and responsiveness to change were evaluated (comparing scores before and after surgery). The median age of the 240-person PROWL-1 analytic sample was 27 years (range, 21-52 years); 49 were women (20.4%). The median age of the 271-person PROWL-2 analytic sample was 30 years (range, 21-57 years); 147 were women (54.2%). Internal consistency reliabilities for the 4 visual symptom scales ranged from 0.96 to 0.98 in PROWL-1 and from 0.95 to 0.97 in PROWL-2. The median (interquartile range) test-retest intraclass correlation was 0.69 (0.57-0.79) and 0.76 (0.68-0.84) in PROWL-1 and PROWL-2, respectively. Product-moment correlations of satisfaction with surgery with visual symptom scales at follow-up evaluations ranged from r = 0.24 to r = 0.49. Measures improved from baseline to follow-up, with effect sizes of 0.14 to 1.98, but scores on the NEI-RQL-42 glare scale worsened at the 1-month follow-up. Hours of work did not change significantly from baseline to 1-month follow-up, with the mean number (mean [SD] difference) in PROWL-1 of 41.7 vs 40.9 hours (-0.8 [18.7]) and in PROWL-2 of 38.8 vs 38.2 hours (-0.6 [17.1]). The results of these studies support the reliability and validity of visual symptom scales to evaluate the effects of LASIK surgery in future studies.

Self-refraction, ready-made glasses and quality of life among rural myopic Chinese children: a non-inferiority randomized trial.

To study, for the first time, the effect of wearing ready-made glasses and glasses with power determined by self-refraction on children's quality of life. This is a randomized, double-masked non-inferiority trial. Children in grades 7 and 8 (age 12-15years) in nine Chinese secondary schools, with presenting visual acuity (VA) ≤6/12 improved with refraction to ≥6/7.5 bilaterally, refractive error ≤-1.0 D and <2.0 D of anisometropia and astigmatism bilaterally, were randomized to receive ready-made spectacles (RM) or identical-appearing spectacles with power determined by: subjective cycloplegic retinoscopy by a university optometrist (U), a rural refractionist (R) or non-cycloplegic self-refraction (SR). Main study outcome was global score on the National Eye Institute Refractive Error Quality of Life-42 (NEI-RQL-42) after 2months of wearing study glasses, comparing other groups with the U group, adjusting for baseline score. Only one child (0.18%) was excluded for anisometropia or astigmatism. A total of 426 eligible subjects (mean age 14.2years, 84.5% without glasses at baseline) were allocated to U [103 (24.2%)], RM [113 (26.5%)], R [108 (25.4%)] and SR [102 (23.9%)] groups, respectively. Baseline and endline score data were available for 398 (93.4%) of subjects. In multiple regression models adjusting for baseline score, older age (p=0.003) and baseline spectacle wear (p=0.016), but not study group assignment, were significantly associated with lower final score. Quality of life wearing ready-mades or glasses based on self-refraction did not differ from that with cycloplegic refraction by an experienced optometrist in this non-inferiority trial.

Assessment of subjective intraocular forward scattering and quality of vision after posterior chamber phakic intraocular lens with a central hole (Hole ICL) implantation

To evaluate the subjective intraocular forward scattering and quality of vision after posterior chamber phakic intraocular lens with a central hole (Hole ICL, STAAR Surgical) implantation. We prospectively examined 29 eyes of 29 consecutive patients (15 men and 14 women; ages, 37.2±8.8years) undergoing Hole ICL implantation. We assessed the values of the logarithmic straylight value [log (s)] using a straylight meter (C-Quant™ , Oculus) preoperatively and 3months postoperatively. The patients completed a questionnaire detailing symptoms on a quantitative grading scale (National Eye Institute Refractive Error Quality of Life Instrument-42; NEI RQL-42) 3months postoperatively. We compared the preoperative and postoperative values of the log(s) and evaluated the correlation of these values with patient subjective symptoms. The mean log(s) was not significantly changed, from 1.07±0.20 preoperatively, to 1.06±0.17 postoperatively (Wilcoxon signed-rank test, p=0.641). There was a significant correlation between the preoperative and postoperative log(s) (Spearman's correlation coefficient r=0.695, p<0.001). The postoperative log(s) was significantly associated with the scores of glare in the questionnaire (Spearman's correlation coefficient r=-0.575, p=0.017). According to our experience, Hole ICL implantation does not induce a significant additional change in the subjective intraocular forward scattering. The symptom of glare after Hole ICL implantation was significantly correlated with the postoperative intraocular forward scattering in relation to the preoperative one.

Long-term quality of life after posterior chamber phakic intraocular lens implantation and after wavefront-guided laser in situ keratomileusis for myopia

To compare the vision-related quality of life 5 years after Implantable Collamer Lens phakic intraocular lens (pIOL) implantation and after wavefront-guided laser in situ keratomileusis (LASIK) for myopia. Department of Ophthalmology, Kitasato University, Kanagawa, Japan. Retrospective case series. Quality of life was measured with the National Eye Institute Refractive Error Quality of Life instrument in consecutive patients 5 years after pIOL implantation or wavefront-guided LASIK to correct myopia. Phakic IOL implantation was performed in 48 patients and LASIK in 55 patients. The scores for activity limitations, symptoms, appearance, and satisfaction with correction were significantly higher in the pIOL group than in the LASIK group (P<.05, Mann-Whitney U test). No significant differences in other scores were observed between the 2 groups (P ≥.05). The scores for near vision and dependence on correction were significantly higher in the younger subgroup than in the older subgroup with both techniques. Phakic IOL implantation may offer significant vision-related quality-of-life advantages (eg, fewer activity limitations and symptoms and better appearance and satisfaction with correction) over wavefront-guided LASIK for myopia in the long term. Moreover, refractive surgery may provide a better quality of life in younger patients.

Patient satisfaction and clinical outcomes with laser refractive surgery performed by surgeons in training

To evaluate the refractive error quality of life (RQL) improvement, patient satisfaction, and clinical results of laser refractive surgery performed by residents or fellows. Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, USA. Case series. This study reviewed the clinical results of consecutive refractive surgery cases performed between March 2010 and February 2012 by ophthalmology residents or fellows. One-year postoperative analysis of the RQL and patient satisfaction in a subgroup of patients was completed using the National Eye Institute Refractive Error Correction Quality of Life-42 instrument (NEI RQL-42), and a comparison with NEI published normative data and post-refractive data was performed. Data were obtained from 138 eyes that had laser in situ keratomileusis and 4 eyes that had photorefractive keratectomy. The 1-year postoperative analysis of the RQL and patient satisfaction was completed in 34 patients. After 6 months postoperatively, the mean uncorrected distance visual acuity was 0.01 logMAR (95% confidence interval [CI], -0.012 to 0.023). The mean postoperative residual refractive error spherical equivalent was -0.20 diopter (D) (95% CI, -0.26 to -0.13). No eye lost corrected distance visual acuity. Equivalent or better satisfaction in the RQL was found in all but 1 of the 13 scale scores of the NEI RQL-42 compared with previously published NEI data. Laser refractive surgery performed by residents and fellows showed high patient satisfaction and an improved RQL 1-year postoperatively. Clinical outcomes validated the safety and efficacy of refractive surgery performed by surgeons in training. No author has a financial or proprietary interest in any material or method mentioned.

Astigmatism correction with toric intraocular lenses: wavefront aberrometry and quality of life

Background/aimTo evaluate wavefront aberrations and subjective quality of life after toric intraocular lens (TIOL) implantation.MethodsThree groups of subjects who underwent unilateral cataract surgery with intraocular lens (IOL) implantation were compared:...

Psychometric properties of the national eye institute refractive error correction quality-of-life questionnaire among Iranian patients

Background and Aim:To evaluate the psychometric properties of the national Eye Institute refractive error correction quality of life questionnaire (NEI-RQL-42) among Iranian patients with refractive errors.Materials and Methods:Two samples of patients (n1 = 296, n2 = 95) were consecutively selected from the eye clinic of the Boo-Ali Hospital, Qazvin. A forward-backward procedure was conducted to translate and cross-culturally adapt the Iranian version of the NEI-RQL-42. A homogeneity, stability, and reliability test was conducted for the first sample after a two-week interval. Convergent validity was computed using the correlation between the NEI-RQL-42 subscale scores, National Eye Institute-Visual Functioning Questionnaire (NEI-VFQ-25), and the Short Form-36 (SF-36). Furthermore, Known-group analysis was performed, to determine the discriminant validity between the subgroups of patients with hyperopia, emmetropia, and myopia. Responsiveness to clinical change was tested by administering NEI-RQL-42 on the second sample that was scheduled for surgery.Results:Homogeneity was satisfactory with the Cronbach’s alpha coefficients ranging between 0.70 and 0.92. The 13 subscales of the NEI-RQL-42 showed a considerable stability in intra-class-correlation (ICC) ranging between 0.70 and 0.89. Positive correlation coefficients were found among all subscales of the NEI-RQL-42 and the other quality-of-life instruments (NEI-VFQ-25 and SF-36). The NEI-VFQ-25 displayed excellent discriminant validity to differentiate the subgroups of patients, and was found to be responsive to change after the surgical correction at three months.Conclusions:The Iranian version of the NEI-RQL-42 is a valid and reliable instrument to assess refractive error correction quality-of-life in Iranian patients. Moreover this questionnaire can be used to evaluate the effectiveness of interventions in patients with refractive errors.

Psychometric Properties of the NEI-RQL-42 Questionnaire in Keratoconus

To assess the psychometric properties of the National Eye Institute Refractive Error Quality of Life (NEI-RQL-42) questionnaire in keratoconus and compare these findings to patients with refractive error correction alone. The Portuguese version of the NEI-RQL-42 Quality of Life questionnaire was completed by 44 patients who had keratoconus before and after implantation of intracorneal ring segments. Rasch analysis was used to assess the use of response categories, success in measuring a single trait per subscale (unidimensionality), ability to discriminate person ability (precision), and targeting of questions to person quality of life (QoL). Rasch analysis was performed for the questionnaire subscales using stacked preoperative and postoperative data. Three subscales (Symptoms, Dependence on correction, and Suboptimal correction) contained response categories that were not used as intended. Six subscales contained misfitting items indicating multidimensionality. Eleven subscales exhibited inadequate measurement precision. Only the Near vision subscale demonstrated adequate precision with a person separation greater than 2.0. Targeting of items to person QoL was adequate in 11 of the 12 subscales with a mean item location of less than 1 logit. Only one NEI-RQL-42 subscale (Near vision) performed adequately in keratoconus. Targeting was better in patients with keratoconus than in patients with refractive error correction alone, but 11 of the 12 subscales remain manifestly inadequate. Better instruments exist for measuring patient-reported outcomes in keratoconus.

Visual and optical performance and quality of life after implantation of posterior chamber phakic intraocular lens

To evaluate visual, optical, and quality of life (QoL) outcomes and intercorrelations after bilateral implantation of posterior chamber phakic intraocular lenses. Twenty eyes with high to moderate myopia of 10 patients that underwent PRL implantation (Phakic Refractive Lens, Carl Zeiss Meditec AG) were examined. Refraction, visual acuity, photopic and low mesopic contrast sensitivity (CS) with and without glare, ocular aberrations, as well as QoL outcomes (National Eye Institute Refractive Error Quality of Life Instrument-42, NEI RQL-42) were evaluated at 12 months postoperatively. Significant improvement in uncorrected (UDVA) and best-corrected distance (CDVA) visual acuities were found postoperatively (p < 0.01), with significant reduction in spherical equivalent (p < 0.01). Low mesopic CS without glare was significantly better than measurements with glare for 1.5, 3, and 6 cycles/degree (p < 0.01). No significant correlations between higher order root mean square (RMS) with CDVA (r = -0.26, p = 0.27) and CS (r ≤ 0.45, p ≥ 0.05) were found. Postoperative binocular photopic CS for 12 cycles/degree and 18 cycles/degree correlated significantly with several RQL-42 scales. Glare index correlated significantly with CS measures and scotopic pupil size (r = -0.551, p = 0.04), but not with higher order RMS (r = -0.02, p = 0.94). Postoperative higher order RMS, postoperative primary coma and postoperative spherical aberration was significant higher for 5-mm pupil diameter (p < 0.01) compared with controls. Correction of moderate to high myopia by means of PRL implantation had a positive impact on CS and QoL. The aberrometric increase induced by the surgery does not seem to limit CS and QoL. However, perception of glare is still a relevant disturbance in some cases possibly related to the limitation of the optical zone of the PRL.

Quality of Life of Myopic Subjects With Different Methods of Visual Correction Using the NEI RQL-42 Questionnaire

To evaluate different aspects of the visual-related quality of life using the National Eye Institute Refractive Error Quality of Life (NEI RQL)-42 questionnaire in low and moderate myopic subjects corrected with different refractive treatments including laser-assisted in situ keratomileusis (LASIK), orthokeratology (OK), soft contact lenses (SCLs), and spectacles. The NEI RQL-42 questionnaire was administered to 217 subjects at one single clinic. All the questions consisted of 13 different subscales that were analyzed separately. The results from subjects with -1.00 to -3.00 diopter myopia corrected with LASIK (n=41), OK (n=37), SCLs (n=44), or spectacles (n=45) were compared with each other and with emmetropic subjects (n=50). Statistically significant differences among all groups were found in all subscales, except for satisfaction with correction (P=0.135). The average decrease in quality of life compared with emmetropes were -7.1% (P=0.021) for LASIK, -13.0% (P<0.001) for OK, -15.8% (P<0.001) for spectacles, and -17.3% (P<0.001) for SCLs. Although all patients in each group were considered to be successfully visually corrected, quality of life related to vision was markedly different in certain NEI RQL-42 categories. LASIK showed the lowest average decrease in quality of vision compared with emmetropes. OK was comparable with LASIK in independence of visual correction, and SCL wear was superior to LASIK and OK lens wear in glare. Except for glare and diurnal fluctuations, contact lenses (SCL and OK) were comparable with or superior to spectacle correction.

Analysis of the correlation between ophthalmic examination and quality of life outcomes following intracorneal ring segment implantation for keratoconus

To analyze the correlation between quantitative measurements outcomes and keratoconus patients' vision related quality of life (v-QoL) following intrastromal corneal ring segment implantation. The NEI-RQL (National Eye Institute Refractive Error Quality of Life) was administered to patients requiring intrastromal corneal ring segment implantation, before and after surgery, wearing best correction for 40 days minimum. Visual acuity, refraction, corneal topography, aberrometry data (VOL-CT. software) and contrast sensitivity were recorded before and 3 months after surgery. The main outcome measures were best corrected visual acuity, refraction, steep keratometric value (Kmax), aberrometry, contrast sensitivity and v-QoL. There were 42 keratoconic patients (69 eyes): 19 male and 23 female, mean age 24.9 ± 5 years in this prospective study. Binocular best corrected visual acuity improved (0.13 ± 0.03 before to -0.01 ± 0.01 logMAR after surgery, p<0.001). There was a statistically significant improvement in mean spherical refraction (2.81 ± 0.44 to 1.71 ± 0.31), cylinder component (3.89 ± 0.22 to 1.82 ± 0.21), spherical equivalent (4.55 ± 0.46 to 2.40 ± 0.30), Kmax (55.92 D ± 0.62 to 52.16 D ± 0.58 D) and root mean square low order (p<0.001). Contrast sensitivity (CS) improved at all spatial frequencies: at 6 cpd improvement was higher. Root mean square higher order did not improved p=0.422. There was significant improvement across all NEI-RQL scales after surgery. Multivariate analysis showed that gender (males more satisfied than females), cylinder (1 D reduction improves 5 points in general NEI-RQL scores) and normal contrast sensitivity at 3 and 6 cpd were correlated with v-QoL. Other variables such as best corrected visual acuity, root mean square low order, root mean square higher order and Kmax did not show influence on NEI-RQL scores. The best patient response predictors with the NEI-RQL instrument were gender, normal CS at 3 and 6 cpd and cylinder reduction. The use of this questionnaire was crucial to assess the influence of optical tests on v-QoL in keratoconus patients who were referred for intrastromal corneal ring segment implantation.

Psychometric properties of the Greek NEI-RQL-42

To evaluate the psychometric properties of the Greek National Eye Institute Refractive Error Quality of Life Questionnaire (NEI-RQL-42). We developed the Greek version of the instrument using forward and backward translation. To examine reliability, Cronbach alpha for each subscale was used as an index of internal consistency. Test-retest reliability was evaluated with intraclass correlation coefficients (ICC). Regarding construct validity, both convergent and discriminant validities were calculated by means of multi-trait analysis. Furthermore, the instrument was evaluated by Rasch analysis, as well. Three patient groups were studied (emmetropes (n = 20), myopes (n = 41), and hyperopes (n = 18)). Emmetropes scored significantly better in the majority of subscales, while myopes scored better than hyperopes in clarity of vision (p = 0.012), near vision (p<0.001), and satisfaction with correction (p = 0.001). Cronbach alpha ranged from 0.490 (glare) to 0.948 (expectations), with most subscales having high internal consistency. The ICCs ranged from 0.76 to 0.93 for all subscales. All items passed the convergent and discriminant validity tests. Strong correlations were detected between uncorrected visual acuity and near vision, expectations, activity limitations, dependence on correction, worry, and suboptimal correction subscales. Rasch analysis revealed potential weaknesses of the instrument that are associated with the assumptions of the model itself. Specifically, 3 items and 17.5% of the participants fell outside the tolerance box. Moreover, principal component analysis indicated average unidimensionality for the instrument. Traditional validation methods indicate that the Greek NEI-RQL-42 scale has adequate psychometric properties for comparative studies in local populations. Rasch analysis indicates significant misfits to the model that should be taken into consideration and evaluated in future studies. These misfits might reflect inherent weaknesses of the original NEI-RQL-42 and not of its adaptation to Greek norms.

Visual perception changes and optical stability after intracorneal ring segment implantation: comparison between 3 months and 1 year after surgery

Purpose:To prospectively evaluate intracorneal ring segment (ICRS) implantation on quality of life (QoL) of patients with keratoconus changes and identify factors responsible.Methods:Sixty-nine eyes of 42 keratoconus patients were implanted with the Keraring (Mediphacos, Belo Horizonte, Brazil). Best corrected visual acuity (BCVA), refraction, and steep keratometry were analyzed 3 months and 1 year after surgery. All patients self-administered the National Eye Institute Refractive Error Quality of life instrument at 2 time points: after having worn best correction for at least 30 days since evaluation (mean 4 months after surgery) and 1 year after surgery. To analyze if the use of the appropriate correction at 1 year follow up had any impact on visual acuity and V-QoL, patients were divided into 2 groups: group A (appropriate correction) and B (not appropriate correction).Results:After 1 year, QoL changes related to scales ‘clarity of vision’, ‘near vision’, and ‘far vision’. Keratometric values, sphere, and spherical equivalent did not differ significantly between 3 months and 1 year postoperative. Cylinder increase was statistically but not clinically significant. Binocular BCVA did not change 1 year after surgery in group A and showed a clinically significant impairment in group B. A year after surgery, 18 patients did not use correction suggested by a physician 3 months after surgery. QoL was not statistically different 1 year after surgery between group A and group B.Conclusion:Our findings show that the way keratoconic patients see is difficult to analyze using only quantitative and 1-visit metrics. They highlight the importance of patients’ self perception and performing longitudinal analysis to consider neural compensation to optical changes from surgery.

Refractive-Error Quality of Life (RQL) in Patients with AcrySof IQ Aspherical Intraocular Lenses

Purpose To compare refractive-error quality of life, and spherical aberration in pseudophakic eyes with an aspherical intraocular lens (AcrySof IQ) vs. a conventional spherical intraocular lens (AcrySof Single-Piece). Methods 65 patients were randomized to implantation of either an aspherical IOL (Alcon AcrySof IQ) (30 eyes) or a spherical IOL (Alcon AcrySof Single-Piece (35 eyes). Three months postoperatively, complete ophthalmologic examinations including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA), and a wavefront analysis were performed. Patients completed the National Eye Institute Refractive Error Quality of life Instrument (NEI RQL) to evaluate vision-related quality of life. Results The mean postoperative best-corrected visual acuity was 0.09±0.07 logMAR in the aspherical group and 0.12±0.08 in the spherical group, and the difference was not statistically significant. Spherical aberrations were significantly lower in the aspherical group (0.12±0.23 μm), than in the spherical group (0.33±0.20 μm) ( P=0.001). Patients with aspherical AcrySof IQ IOLs implantation also experienced less difficulties driving at night ( P=0.04), but the difference was not significant after Bonferroni correction. Conclusion The NEI RQL instrument is sensitive enough to detect the visual benefit of cataract surgery. The aspherical AcrySof IQ IOL reduces both spherical aberration and total higher-order aberrations, compared with the performance achieved by the spherical AcrySof Single-Piece IOL. Although the difference between the two IOLs is not statistically significant, there is a tendency toward the association of objective optical performance of aspherical AcrySof IQ IOLs with a subjective improvement in patients’ night driving.

Evaluation of the impact of intracorneal ring segments implantation on the quality of life of patients with keratoconus using the NEI-RQL (National Eye Institute Refractive Error Quality of life) instrument

Background/aims:A prospective study evaluating the impact of intracorneal ring segment (ICRS) implantation on the quality of life of patients with keratoconus using the NEI-RQL (National Eye Institute Refractive Error Quality...

The Turkish version of the National Eye Institute Refractive Error Quality of Life Instrument: translation, validity and reliability

To translate the original 42-item National Eye Institute Refractive Error Quality of Life Questionnaire (NEI-RQL-42) into Turkish and to investigate its validity and reliability. The linguistic translation followed the international guidelines of forward and backward translation. Ninety-five consecutive subjects (37 myopes, 18 hyperopes and 40 emmetropes) who had a visual acuity of 0.8 or better in the worse eye completed the NEI-RQL-42 and the Turkish version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25). Eighty patients completed the NEI-RQL-42 for a second time within 2 weeks. Psychometric evaluation of the Turkish NEI-RQL-42 involved the assessment of internal consistency, test-retest reliability, convergent and known-groups validity. Internal consistency was generally high (Cronbach's alpha = 0.83-0.95), with the exception of three subscales (glare, alpha = 0.65; suboptimal correction, alpha = 0.66; appearance, alpha = 0.62). Test-retest reliability, assessed by the intraclass correlation coefficient was good (ICC = 0.74-0.95) except for the subscale suboptimal correction (ICC = 0.61). Almost all subscales and the overall score showed significant inter-correlations. Low to moderate correlations were found between the subscales of the NEI-RQL-42 and the NEI-VFQ-25, which measure similar constructs. The NEI-RQL-42 showed good construct validity in terms of refractive error (myopia, hyperopia and emmetropia) and mode of refractive correction (spectacles, contact lens and no correction) discrimination. The Turkish version of the NEI-RQL-42 is a reliable and valid measure of vision-related quality of life in patients with refractive error.

Efficacy of Cyclosporine 0.05% Ophthalmic Emulsion in Contact Lens Wearers With Dry Eyes

To assess the efficacy of cyclosporine 0.05% ophthalmic emulsion (Restasis; Allergan, Inc., Irvine, CA) in the treatment of contact lens wearers with dry eyes. Contact lens wearers citing dry eye problems were identified through chart review. Participants were randomly assigned to a treatment group, receiving vials of cyclosporine 0.05% ophthalmic emulsion to use twice daily, or a placebo group, receiving vials of rewetting drops (Refresh Preservative Free Artificial Tears; Allergan, Inc.) to use twice daily. Corneal staining, tear film breakup time, and Schirmer test results were documented at baseline and after 3 months. Participants also completed questionnaires, the Ocular Surface Disease Index, and the National Eye Institute Refractive Error Quality of Life Instrument at baseline and after 3 months. For all parameters, including objective findings and subjective reporting of symptoms, there was no statistically significant difference between the treatment and placebo groups. This study did not detect a beneficial effect in using cyclosporine 0.05% ophthalmic emulsion over rewetting drops for contact lens wearers. This may be attributable to the small sample size. It is also possible that the mechanism of the dry eye state in contact lens wearers may be different from that of other dry eye states and thus make cyclosporine 0.05% ophthalmic emulsion an ineffective treatment.

Visual Function and Change in Quality of Life After Bilateral Refractive Lens Exchange With the ReSTOR Multifocal Intraocular Lens

To evaluate vision and quality of life and explore the correlation between vision and change of quality of life after bilateral refractive lens exchange of the Acrysof SA60D3 ReSTOR multifocal intraocular lens (IOL) for correction of ametropia in presbyopic populations. Pre- and postoperatively, the National Eye Institute Refractive Error Quality of Life Instrument (NEI-RQL) was self-administered by 30 consecutive refractive lens exchange patients, including 19 myopes and 11 hyperopes. The change of NEI-RQL scores was determined for each subscale covering a specific aspect of quality of life. Refraction, visual acuity, and contrast sensitivity function were evaluated 3 and 6 months postoperatively. Postoperatively, all patients achieved binocular uncorrected distance and near visual acuity of 20/30 or better. Photopic contrast sensitivity function decreased significantly at high spatial frequencies (P < .05). Overall scores of expectations, activity limitations, dependence on correction, appearance, and satisfaction were significantly higher postoperatively (P < .05). Greater improvement in near vision and dependence on correction was achieved in hyperopes. However, glare scores were significantly lower postoperatively (P < .001). Lower preoperative uncorrected near visual acuity was associated with higher scores for dependence on correction in myopes (r = 0.51, P = .027), and overall patient satisfaction correlated significantly with postoperative uncorrected distance visual acuity (r = -0.44, P = .015). Refractive lens exchange with the ReSTOR IOL in presbyopic patients provided good visual function and better patient satisfaction compared with preoperative corrections. Improvement in vision-related quality of life was most evident in hyperopes. A slight reduction in contrast sensitivity function appears to have no influence on quality of life.

Evaluation of the Relationship Between Ablation Diameter, Pupil Size, and Visual Function With Vision-Specific Quality-of-Life Measures After Laser In Situ Keratomileusis

To evaluate the relationship between ablation diameter, pupil size, and visual function as measured by a vision-specific quality-of-life instrument after undergoing laser in situ keratomileusis. Of 300 patients eligible for this study, 97 (32.3%) responded to a mailed study questionnaire, the National Eye Institute Refractive Error Quality of Life (RQL) Instrument. The RQL Instrument was administered in all 97 patients after laser in situ keratomileusis. Spearman correlation coefficients were calculated for the association between RQL subscale scores and characteristics including pupil diameter and uncorrected visual acuity. Positive correlations between larger mesopic and scotopic pupil diameter and higher RQL satisfaction scores (0.12 and 0.19, respectively) were not statistically significant at the P=.05 level. As uncorrected visual acuity in the better eye improved, patients reported significantly less worry (-0.22; P=.03), more satisfaction (-0.25; P=.01), clearer vision (-0.25; P=.01), and better far vision (-0.24; P=.02). Larger pupil diameter is not significantly associated with postoperative satisfaction and visual function as measured with the RQL. Rather, postoperative uncorrected visual acuity is confirmed as a strong predictor of patient satisfaction after refractive surgery.

The Effect of Overnight Contact Lens Corneal Reshaping on Refractive Error-Specific Quality of Life

The purpose of this study is to determine the effect of corneal refractive therapy (CRT) on refractive error-specific quality of life. The National Eye Institute Refractive Error Quality of Life Instrument (NEI RQL-42) was administered to 20 myopic patients (mean spherical equivalent -3.11 D +/- 0.96 D) between the ages of 21 and 37 years both before and 1 month after being successfully fit with Paragon CRT lenses. High- and low-contrast best-corrected visual acuity (BCVA) and higher-order aberrations were also measured. Scores for the 13 NEI RQL-42 subscales were calculated and a Wilcoxon sign rank test was used to determine whether there was a significant change in each of the subscale scores. Post hoc power analyses were also performed. Statistically significant changes were found in three of the 13 NEI RQL-42 subscales. Significant improvements in subscale score were found for the symptoms (mean +/- standard deviation, 10.18 +/- 10.57, p = 0.0007) and dependence on correction (43.13 +/- 27.42, p < 0.0001) subscales. A significant reduction was found in the glare subscale (-32.50 +/- 35.22, p = 0.001). No significant changes were found in the clarity of vision, expectations, near vision, far vision, diurnal fluctuations, activity limitations, worry, suboptimal correction, appearance, or satisfaction with correction subscales. CRT may improve a patient's perception of their visual independence, decrease the amount of ocular symptoms they report, and increase symptoms of glare. A larger, well-controlled clinical trial is necessary to verify these results. An increase in patient-reported glare is likely the result of measured increases in higher-order aberrations after CRT, especially spherical aberration under mesopic and scotopic conditions.