Visual Function Scores Research Articles

First Metatarsophalangeal Joint Arthrodesis Technique With Interposition Allograft Bone Block.

We present a technique of first metatarsophalangeal joint arthrodesis utilizing an interposition allograft bone block with a bipolar reaming technique that creates congruent fusion surfaces on both ends of the graft-host bone interface. In addition, we examined the union rates, fusion position, patient satisfaction, and functional outcome of this technique. Fifteen patients underwent first metatarsophalangeal joint arthrodesis with an interposition allograft bone block between September 2004 and October 2013. Charts and radiographs were reviewed. Six measures were compared on preoperative and postoperative radiographs. Clinical outcomes were measured using a telephone questionnaire, pre- and postoperative visual analog scale pain scale, and Foot and Ankle Ability Measure. Average follow-up was 46 weeks (range, 19 to 97). Thirteen of 15 (87%) patients achieved bony union at an average of 21 weeks. One patient underwent revision arthrodesis for their nonunion. Symptomatic hardware was removed in 3 cases. Improvement was noted in visual analog scale pain scores (6 to 2) and functional scores as measured by the Foot and Ankle Ability Measure. There were no postoperative wound complications or infections. Average length of the first ray on anteroposterior radiograph increased from 10.7 to 11.3 cm and from 10.0 to 10.7 cm on the lateral radiograph. Thirteen of 14 patients were very satisfied or satisfied. One patient expressed dissatisfaction with the procedure. One patient was not available for clinical follow-up. First metatarsophalangeal joint allograft bone block arthrodesis using the bipolar reaming technique achieved high bony union rates and satisfactory radiographic and clinical outcomes. This procedure was an effective salvage option for managing bone loss on 1 or both sides of the joint. Level IV, retrospective case series.

Visual Outcomes at 12Months in Patients Following Implantation of a Diffractive Multifocal Intraocular Lens.

IntroductionThe aim of this study was to assess distance, intermediate, and near visual acuity, contrast sensitivity, and patient satisfaction outcomes of a multifocal intraocular lens (IOL).MethodsThis multicenter, prospective clinical study was conducted at seven study sites in Turkey. Patients who underwent bilateral cataract removal and implantation of a diffractive, acrylic, hydrophobic, multifocal IOL (Acriva UD Reviol MFB 625; VSY Biotechnology, Istanbul, Turkey) were included. The uncorrected and best corrected distance visual acuities (UCDVA and BCDVA), uncorrected and best corrected intermediate visual acuities (UCIVA and BCIVA), and uncorrected and best corrected near visual acuities (UCNVA and BCNVA) were measured preoperatively and at postoperative 1, 6, and 12 months. Distance and near visual acuity scores (VAS) contrast sensitivities were measured at these time points. Quality of life was evaluated by visual function-14 (VF-14) questionnaire.ResultsTwo hundred eyes of 100 patients were included. Monocular and binocular visual acuities at all distances showed improvement at postoperative 12 months compared to preoperative measurements (P < 0.001). Monocular and binocular UCIVA and binocular BCIVA at postoperative 12 months were significantly improved compared to measurements at 1 month (P < 0.001). Binocular contrast sensitivity at distance showed significant improvement from postoperative 1 month to postoperative 12 months, except for 3 cycles per degree (cpd; without glare) and 18 cpd (with glare). VAS improved from 75.96 at postoperative 1 month to 76.85 at postoperative 12 months. VF-14 score was 98.2 ± 4.6.ConclusionThe Acriva UD Reviol MFB 625 appears to provide a good level of distance and near visual acuity, quality of life, and patient satisfaction. Further studies with longer follow-up will provide valuable insight into the long-term stability of these visual outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s40123-015-0032-4) contains supplementary material, which is available to authorized users.

Current status of age-related eye diseases in elderly population and their visual function and visual-related quality of life

Objective To explore the prevalence of age-related eye diseases (AREDs) among people aged 70 years or above in Hangzhou and evaluate the impact of AREDs on visual function (VF) and visual-related quality of life (QOL) in elders. Methods This study involved a total 2 111 elderly people (≥70 years). All participants received visual acuity and comprehensive eye examinations and complete VF and QoL questionnaires. Results The main cause of visual impairment was AREDs. And the causes were age-related cataract (79.82%), AMD (45.64%), glaucoma (10.95%) and diabetic retinopathy (DR, 7.30%). VF and QoL scores declined gradually with age. And the scores declined more rapidly with declined visual acuity among the elders. VF and QoL scores in patients with age-related cataract, AMD, glaucoma and DR were successively lower. After adjusting for age, gender and visual acuity, the elders with AREDs had lower scores across all domains of VF and QoL. Scores for subscales of VF and QoL domains were significantly lower among those with DR and glaucoma compared with those with age-related cataract and AMD. Conclusion Age, presenting vision and AREDs are associated with VF and QoL in this elderly population. And senile people with glaucoma and DR have severe declines in VF and QoL, independent of presenting visual acuity. Key words: Elderly population; Eye diseases, age-related; Visual function; Quality of life

No difference in clinical outcome between patella eversion and lateral retraction in total knee arthroplasty: a systemic review and meta-analysis.

Surgical exposure during total knee arthroplasty (TKA) requires mobilization technique of the patella. Proponents of minimally invasive TKA claim that lateral retraction, rather than eversion, of the patella may be beneficial. Many randomized controlled studies attempt to identify this issue; however, no final conclusion arrives. With this systemic review and meta-analysis, we intended to test whether patella eversion during TKA had deleterious effects. A comprehensive literature search was performed in PubMed, MEDLINE, EMBASE and other internet database. We retrieved all the relevant studies designed to interpret this issue. The searching time frame was from the establishing of these databases until July 2014. Six randomized controlled trials assessing a total of 414 patients and 451 knees were included. The duration of surgery was much shorter (p = 0.003), and the length of skin incision was much longer (p < 0.00001). No significant difference was found on other measurements, including length of hospital stay, quadriceps strength, complications, straight leg raise, Visual Analogue Scale score and functional scores. Patella eversion could decrease the duration of the surgery; nevertheless, the length of skin incision was longer; no significant difference was found on other measurements, especially the quadriceps strength and complications which were concerned. Patella eversion and patella lateral retraction could achieve similar clinical outcomes. Systematic review and meta-analysis, Level I.

Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery.

Context:Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery.Aims:To compare the cost effectiveness of phacoemulsification (PE) versus manual small-incision cataract surgery (MSICS).Settings and Design:Prospective randomized controlled trial. Tertiary care hospital setting.Subjects and Methods:A total of 52 consenting patients with age-related cataracts, were prospectively recruited, and block randomized to PE or MSICS group. Preoperative and postoperative LogMAR visual acuity (VA), visual function-14 (VF-14) score and their quality-adjusted life years (QALYs) were obtained, and the change in their values calculated. These were divided by the total cost incurred in the surgery to calculate and compare the cost effectiveness and cost utility. Surgery duration was also compared.Statistical Analysis Used:Two group comparison with Student's t-test. Significance set at P < 0.05; 95% confidence interval (CI) quoted where appropriate.Results:Both the MSICS and PE groups achieved comparative outcomes in terms of change (difference in mean [95% CI]) in LogMAR VA (0.03 [−0.05−0.11]), VF-14 score (7.92 [−1.03−16.86]) and QALYs (1.14 [−0.89−3.16]). However, with significantly lower costs (INR 3228 [2700–3756]), MSICS was more cost effective, with superior cost utility value. MSICS was also significantly quicker (10.58 min [6.85–14.30]) than PE.Conclusions:MSICS provides comparable visual and QALY improvement, yet takes less time, and is significantly more cost-effective, compared with PE. Greater push and penetration of MSICS, by the government, is justifiably warranted in our country.

Visual function and vision-related quality of life in presbyopic adult population of Northwestern Nigeria.

Purpose:To determine the impact of uncorrected presbyopia on vision-related quality of life (QoL) and visual function (VF) among adults 40 years and older in Bungudu local government area (LGA) of Zamfara State, Nigeria.Materials and Methods:A population-based cross-sectional study in Bungudu LGA of Zamfara State Nigeria was conducted in 2012. Six-hundred and fifty persons at least 40 years of age were examined using a two-stage cluster random sampling-based on probability proportional to size. Presbyopia was defined as the inability to read N8 at 40 cm in an indoor illumination using LogMAR E-chart. Demographic information comprising of age, sex, occupation, and educational level among others was obtained from a pilot tested VF-14 and modified vision-related QoL questionnaire by trained interviewer.Results:Out Of the 650 subjects enumerated 635 were examined given a response rate of 97.7%. The mean age of participants was 53.59 years (95% confidence interval:52.75%-54.43%). The crude prevalence of presbyopia was 30.4%, (95% CI: 26.8%-34.1%). The mean VF score of persons with presbyopia was 85.09, (95% CI: 83.09%-87.09%) and being female was strongly associated with high VF scores (P = 0.003). The VFs most impaired were the ability to read, write, use mobile phones, and thread needles. The higher the degree of presbyopia the lower the mean VF score (P = 0.00).Conclusion:Uncorrected presbyopia is associated with functional visual impairment and reduce QoL especially in the ability to read, write, and usage of mobile cell phones among adults 40 years and older in Bungudu District.

The impact of hospital rehabilitation on functional outcomes and quality of life after total knee arthroplasty

Objective: The objective of the study was to investigate the impact of rehabilitation program performed in hospital on functional outcomes and quality of life after total knee arthroplasty (TKA). Material and Methods: The trial included 374 patients (307 female and 67 male; age range 47–85 years) who had undergone TKA. The patients in group I (n=123) were included in an inpatient rehabilitation program at a physical medicine and rehabilitation hospital, whereas the patients in group II (n=251) were provided a home exercise program. Knee pain at rest using the visual analog scale, functional and knee scores of the Knee Society Clinical Rating System, and Short Form-36 (SF-36) questionnaire were used as outcome measures. Results: The percentage change in the physical component score of the SF-36 was significantly higher in the patients of the hospital-based program than in those of the home-based program, whereas the mental component score revealed no difference between the groups (p=0.001 and p>0.05, respectively). The percentage of improvement was not different between groups in terms of knee pain and knee score of the Knee Society (p>0.05). Conclusion: The results demonstrated that the rehabilitation program performed in the hospital was more effective with respect to the functional status than the home exercise program after TKA.

Improvement in visual function and quality of life following a blindness prevention surgery program in a rural area of Eastern China

The aim of this study was to assess the changes in visual function (VF) and quality of life (QOL) among patients following blindness prevention surgery in a rural area of Eastern China. The prospective study selected cataract patients via mobile eye screening camps. VF and QOL questionnaires originally developed by Fletcher et al were completed prior to and 6 months after surgery. Small-incision cataract surgery (SICS) with posterior chamber intraocular lens (IOL) implantation was performed on patients by a blindness prevention surgery group. The VF and QOL scores of 178 cataract patients preoperatively were 48.58±31.18 and 65.97±26.77, respectively. The scores decreased in proportion to decreasing vision status. The VF and QOL scale scores were significantly correlated with the vision grade of the patient (rVF=−17.2093, t=−10.87, P<0.001, rQOL=−13.1399, t=−8.87, P<0.001) and age (rVF=−0.6505, t=−3.87, P<0.001, rQOL=− 0.3309, t=−2.10, P=0.037). A total of 131 patients responded to the second survey, VF and QOL scores increased significantly over a six-month postoperative period (VF=83.21±16.40, P<0.001; QOL=86.53±16.33, P<0.001). The VF scale scores were correlated with the grade of vision and residence area, the QOL scale scores were correlated with the grade of vision and gender. The VF and QOL of patients were significantly improved by performing SICS with posterior chamber IOL implantation collectively in a short period in rural areas of Eastern China. It is important to follow-up cataract patients postoperatively as untreated complications of the surgery may affect the stability of VF and QOL postoperatively.

Evaluation of changes in retinal nerve fiber layer thickness and visual functions in cases of optic neuritis and multiple sclerosis

Context:Retinal nerve fiber layer (RNFL) thinning has been demonstrated in cases of optic neuritis (ON) and multiple sclerosis (MS) in Caucasian eyes, but no definite RNFL loss pattern or association with visual functions is known in Indian eyes.Aim:To evaluate RNFL thickness in cases of ON and MS, and to correlate it with visual function changes in Indian patients.Settings and Design:Cross-sectional case-control study at a tertiary level institution.Materials and Methods:Cases consisted of patients of (i) typical ON without a recent episode (n = 30:39 ON eyes and 21 fellow eyes), (ii) MS without ON (n = 15;30 eyes) while the controls were age-matched (n = 15; 30 eyes). RNFL thickness was measured using the Stratus 3°CT. The visual functions tested included the best-corrected visual acuity (BCVA), contrast sensitivity, stereopsis, visual evoked responses, and visual fields.Statistical analysis used:Intergroup analysis was done using ANOVA and Pearson's correlation coefficient used for associations.Results:RNFL thickness was reduced significantly in the ON and MS patients compared to the controls (P-0.001). Maximum loss is in the temporal quadrant. Lower visual function scores are associated with reduced average overall RNFL thickness. In ON group, RNFL thinning is associated with severe visual field defects while contrast sensitivity has strongest correlation with RNFL in the MS group.Conclusions:RNFL thickness is reduced in ON and MS cases in a pattern similar to Caucasians and is associated with the magnitude of impairment of other visual parameters. Contrast sensitivity and stereoacuity are useful tests to identify subclinical optic nerve involvement in multiple sclerosis.

Reconstruction for anterior sternoclavicular joint dislocation and instability

Sternoclavicular joint (SCJ) instability is relatively rare. Surgical treatment may be considered for severely displaced dislocations or symptomatic recurrent anterior instability. The purpose of this study was to describe an SCJ ligament reconstruction technique and retrospectively evaluate its safety and effectiveness for treating anterior SCJ dislocations and instability. A retrospective review of demographics, medical history, injury characteristics, and pretreatment pain and functional levels was performed. A soft-tissue graft woven in a Roman numeral X pattern through clavicular and sternum subcortical bone tunnels was used. Patients were evaluated with postoperative visual analog scale (VAS) and functional scores, and their ability to return to normal preoperative sports and activities was determined. Six patients were evaluated with a mean follow-up of 40 months (range, 24.5-58 months). Injury mechanisms included acute trauma (3 patients), minor trauma (1 patient), and chronic atraumatic instability (2 patients). The mean preoperative symptom duration was 11 months (range, 0.5-27.5 months). Autograft hamstring graft was used in all cases with no resulting surgical complications. All 6 patients had full range of motion with no instability after treatment. Five patients had no pain (0 of 10 on VAS), whereas one patient had mild pain (1 to 3 of 10 on VAS). All 6 patients had improved functional scores.All returned to preoperative activities and participation in sports. No recurrent instability occurred. In 1 case, failure occurred at 4 years with recurrent pain, and revision was performed. The results of our study indicate that reconstruction for anterior SCJ dislocation is safe with results comparable to previously described surgical stabilization techniques. This technique provides a surgical treatment option for symptomatic anterior SCJ dislocation and instability.

Impact of clinical and patient‐reported outcomes on patient satisfaction with cataract extraction

To date, factors that influence satisfaction with cataract surgery have not been broadly explored. To identify variables related to patient satisfaction after cataract extraction by phacoemulsification and to determine the relationship between satisfaction and visual acuity (VA) and visual function (VF). Prospective cohort study. Five hospitals belonging to the Basque Health Care Service. 4335 consecutive patients undergoing cataract extraction. Clinical data on vision were collected before the intervention and 6 weeks afterwards. Before cataract extraction, patients answered a global question about their expectations for the procedure, answered three questions related to specific activities (reading, going out and recognizing people, and doing housework) and completed the Visual Function-14 (VF-14) and Short-Form-36 (SF-36) instruments. Three months after cataract extraction, they again completed the VF-14 and SF-36 along with questions about global satisfaction with the procedure and satisfaction with the three specific activities. Three months after cataract extraction, they again completed the VF-14 and SF-36 along with questions about global satisfaction with the procedure and satisfaction with the three specific activities. Pre-intervention VA and VF-14 scores and their post-intervention changes were associated with both global satisfaction and satisfaction with the ability to perform specific activities. Unresolved ocular complications were related to global satisfaction with cataract extraction (OR 95% = 0.39(0.27, 0.55) , P < 0.001). Both the mental and physical component scales of the SF-36 were related to global satisfaction. A group of patients were not satisfied with the intervention in spite of achieving similar vision-related improvements as patients who were quite satisfied with the procedure. Satisfaction with cataract extraction is related to clinical outcomes and is also associated with patients' expectations of their improvement in visual function.

Refractive Error and Visual Function Difficulty in a Latino Population

To assess the association of correction of myopia, hyperopia, and astigmatism with self-reported near and distance visual function. Population based, cross-sectional study. A random sample of 4272 Latinos older than 40 years of age from Arizona with both ophthalmic examination and questionnaire data, including answers to the National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25). Cases of refractive error (RE) were defined as subjects who met at least 1 of the following criteria in both eyes: myopia, sphere -0.5 diopters (D) or less; hyperopia, sphere 1.0 D or more; or astigmatism, cylinder 0.75 D or more. Uncorrected refractive error (URE) was defined as having RE and achieving 2 lines or more of improvement in visual acuity in both eyes after refraction. The association between RE category and near and distance vision difficulty (as measured by the NEI VFQ-25 near and distance vision subscores) was modeled with ordinal logistic regression, adjusting for age, gender, diabetes, hypertension, income, education, and acculturation. Association between RE correction and near and distance vision difficulty by type of RE (myopia, hyperopia, and astigmatism). Of 4272 participants, 54% had RE. Forty-eight percent of these had myopia, 41% had hyperopia, and 11% had astigmatism. Fourteen percent of myopes, 21% of hyperopes, and 22% of astigmatics had URE. Subjects with myopia, astigmatism, and hyperopia were significantly more likely to report more distance vision difficulty than subjects without RE, regardless of whether they had correction (odds ratios [ORs], 1.7-3.7; P<0.005 for all). Subjects with corrected myopia reported less near vision difficulty than subjects without RE (OR, 0.8; 95% confidence interval [CI], 0.7-0.9). Subjects with uncorrected hyperopia and uncorrected astigmatism reported more near vision difficulty than those without RE (OR, 1.6; 95% CI, 1.2-2.2; and OR, 1.7; 95% CI, 1.0-3.0, respectively). Self-reported distance and near visual function scores were sensitive to nonvision variables, namely, age, gender, diabetes, high blood pressure, acculturation score, income, and education. In this population, correction of any type of RE is not entirely sufficient to restore distance visual function to the level of those without RE. More research is necessary to determine the reasons for this shortcoming.

Associations among Visual Acuity and Vision- and Health-Related Quality of Life among Patients in the Multicenter Uveitis Steroid Treatment Trial

To evaluate the associations between visual acuity and self-reported visual function; visual acuity and health-related quality of life (QoL) metrics; a summary measure of self-reported visual function and health-related QoL; and individual domains of self-reported visual function and health-related QoL in patients with uveitis. Best-corrected visual acuity, vision-related functioning as assessed by the NEI VFQ-25, and health-related QoL as assessed by the SF-36 and EuroQoL EQ-5D questionnaires were obtained at enrollment in a clinical trial of uveitis treatments. Multivariate regression and Spearman correlations were used to evaluate associations between visual acuity, vision-related function, and health-related QoL. Among the 255 patients, median visual acuity in the better-seeing eyes was 20/25, the vision-related function score indicated impairment (median, 60), and health-related QoL scores were within the normal population range. Better visual acuity was predictive of higher visual function scores (P ≤ 0.001), a higher SF-36 physical component score, and a higher EQ-5D health utility score (P < 0.001). The vision-specific function score was predictive of all general health-related QoL (P < 0.001). The correlations between visual function score and general quality of life measures were moderate (ρ = 0.29-0.52). The vision-related function score correlated positively with visual acuity and moderately positively with general QoL measures. Cost-utility analyses relying on changes in generic healthy utility measures will be more likely to detect changes when there are clinically meaningful changes in vision-related function, rather than when there are only changes in visual acuity. (ClinicalTrials.gov number, NCT00132691.).

The impact of bilateral or unilateral cataract surgery on visual functioning: when does second eye cataract surgery benefit patients?

AimTo examine the impact of bilateral or unilateral cataract surgery on visual functioning.MethodsThe Singapore Malay Eye Study is a population-based study of 3280 Singapore Malay patients aged 40–80 years, of...

The role of autologous chondrocyte implantation in the treatment of symptomatic chondromalacia patellae

Chondromalacia patella is a distinct clinical entity of abnormal softening of the articular cartilage of the patella, which results in chronic retropatellar pain. Its aetiology is still unclear but the process is thought to be a due to trauma to superficial chondrocytes resulting in a proteolytic enzymic breakdown of the matrix. Our aim was to assess the effectiveness of autologous chondrocyte implantation on patients with a proven symptomatic retropatellar lesion who had at least one failed conventional marrow-stimulating therapy. We performed chondrocyte implantation on 48 patients: 25 received autologous chondrocyte implantation with a type I/III membrane (ACI-C) method (Geistlich Biomaterials, Wolhusen, Switzerland), and 23 received the Matrix-assisted Chondrocyte Implantation (MACI) technique (Genzyme, Kastrup, Denmark). Over a mean follow-up period of 40.3months, there was a statistically significant improvement in subjective pain scoring using the visual analogue scale (VAS) and objective functional scores using the Modified Cincinnati Rating System (MCS) in both groups. Chondromalacia patellae lesions responded well to chondrocyte implantation. Better results occurred with MACI than with ACI-C. Excellent and good results were achieved in 40% of ACI-C patients and 57% of MACI patients, but success of chondrocyte implantation was greater with medial/odd-facet lesions. Given that the MACI procedure is technically easier and less time consuming, we consider it to be useful for treating patients with symptomatic chondral defects secondary to chondromalacia patellae.

Persistent ocular motor manifestations and related visual consequences in multiple sclerosis

Abnormal eye movements in multiple sclerosis (MS) are often persistent and known to be associated with general disability. However, there is no precise knowledge concerning their incidence and resulting visual handicap. The aim of our study was to describe the persistent ocular motor manifestations in MS and relate them to visual functions tested with visual acuity and with a vision-related questionnaire. We selected 24 MS patients complaining of persistent visual disability associated with ocular motor manifestations without any anterior visual pathway deficit. Internuclear ophthalmoplegia was the most frequently observed symptom, followed by gaze-evoked nystagmus, saccadic hypermetria, and then pendular nystagmus. Pendular nystagmus, saccadic hypermetria, and the association of internuclear ophthalmoplegia and gaze-evoked nystagmus were associated with decreased visual acuity and visual functional scores. There was a correlation between the number of abnormal eye movements and visual functions. This study demonstrates that ocular motor dysfunction in MS induces specific visual dysfunction and handicap.

Quality of life and visual function in Nigeria: findings from the National Survey of Blindness and Visual Impairment

AimsTo assess associations of visual function (VF) and quality of life (QOL) by visual acuity (VA), causes of blindness and types of cataract procedures in Nigeria.MethodsMulti-stage stratified cluster random sampling...

Evaluating the safety and effectiveness of percutaneous acetabuloplasty

PurposeTo evaluate the safety and effectiveness of percutaneous acetabuloplasty in treating the pain and disability related to metastatic lesions of the acetabulum.Materials and methodsThis institutional review board approved retrospective study...

The impact of the severity of vision loss on vision-specific functioning in a German outpatient population — an observational study

To validate the German-translated VF-14, a vision-specific scale, and determine the relationship between the severity of vision impairment, ocular conditions, and visual functioning. This was a clinic-based, cross-sectional study with 184 patients with low vision and 90 normal-sighted controls recruited from a German eye hospital. Participants underwent a clinical examination and completed the German VF-14 scale. The validity of the VF-14 scale was assessed using Rasch analysis. The main outcome measure was the visual functioning overall score. The participants' mean ± SD [standard deviation] age was 59.4 ± 21.8 years ,and there were more female (58.4%) than male participants. The main cause of vision loss was age-related macular degeneration [AMD] (n = 54, 19.7%). Rasch analysis substantiated the German VF-14 to be a valid scale to assess visual functioning in the sample. Visual functioning consistently declined with worsening vision. In adjusted-multivariate analysis models, compared to control participants, those with mild, or moderate/severe vision impairment recorded significantly poorer visual functioning scores (p < 0.05). The independent association was clinically significant for those with moderate/severe vision impairment. The main ocular conditions were also found to be independently associated with worse visual functioning, with clinical significance found for AMD, diabetic retinopathy, and other retinal diseases. Using a psychometrically valid German-translated VF-14, even mild vision impairment was independently associated with poor visual functioning. These findings reinforce the importance of early preventative and rehabilitative efforts to prevent longitudinal deterioration in vision loss.

Change in quality of life after medical and surgical treatment of graves′ ophthalmopathy

Purpose:To assess the changes in quality of life (QOL) of patients after treatment of their Graves’ ophthalmopathy (GO).Materials and Methods:In this prospective, cross-sectional study, the GO-QOL questionnaire was completed by 67 subjects before and at least 6 months after steroid treatment (61 subjects, group 1) or optic neuropathy orbital decompression (6 subjects, group 2). Visual, psychosocial, education and counseling scores (higher score = better health), GO severity and clinical activity scores and minimal clinically important difference (MCID) were recorded and analyzed for correlation and statistical significance. A P-value <0.05 was considered statistically significant.Results:The mean age of patient enrolled in the study was 38.3 years, with 43 females (64.2%). The mean duration of thyroid dysfunction and GO were 40.1 and 26.5 months, respectively. Two treatment groups were similar for all the variables (0.06 < P < 0.9), except for higher mean age in the orbital decompression group (45.2 versus 37.7 years) (P = 0.03). Mean severity, activity, visual function and psychosocial function scores significantly improved in group 1 (steroid group) (P < 0.05, all cases). A significant improvement in clinical activity score and psychosocial scores occurred in group 2 (decompression group) (P < 0.05). MCID was achieved in two-thirds of the patients, with no significant difference between groups (P > 0.05). There was no significant effect of duration of thyroid disease and GO and severity and activity of GO on QOL scores either before or after treatment (P > 0.05, all cases).Conclusion:Steroid treatment and orbital decompression significantly improve the QOL in GO. Duration, severity and activity of GO did not have a significant impact on the QOL.