Highlights of April’s Ophthalmology, the journal of the American Academy of Ophthalmology (Academy), include the first international, peer-reviewed report on LASIK patient satisfaction, data on increased cataract risk in patients who use combined steroids, and the first large study of refractive error and vision correction in American preschool children.
Comprehensive Review Confirms High LASIK Patient Satisfaction
This peer-reviewed report provides a systematic worldwide overview of LASIK patient satisfaction as of 2008. Report findings were first released last year by the American Society of Cataract and Refractive Surgery (ASCRS). LASIK has been assessed and improved by more than a decade of clinical studies and technological innovation since the procedure was introduced. The report notes that 16.3 million surgeries have been performed worldwide to date, and about one million LASIK surgeries are done annually in the United States.
The review found an overall patient satisfaction rate of 95.4 percent (2,097 of 2,198 subjects), with a range of 87.2 to 100 percent. “This places LASIK among the most successful of all elective surgeries, comparing very favorably with other elective procedures,” said lead researcher Kerry D. Solomon, MD, Magill Vision Center and Storm Eye Institute, Medical University of South Carolina. “Because this review process was systematic, transparent, and based on carefully vetted international and U.S. research, the findings are highly reliable.” Measuring patient satisfaction is increasingly important in health care. For an elective surgery like LASIK, satisfaction criteria include whether the patients’ physical, emotional, and financial expectations are met and physical and psychological benefits achieved.
The researchers looked at whether patient satisfaction with LASIK has changed over time by comparing rates for surgeries performed 1995 to 2000 with those performed 2001 and after. The rate was 96.0 percent in the earlier period and 94.6 percent in the later period, confirming consistently high patient satisfaction. The review also analyzed satisfaction rates in relation to questionnaire characteristics, administration methods and timing, type of patient refractive error (near- or farsightedness, astigmatism) and country. All analyses showed very high overall patient satisfaction rates. Questionnaires used in all studies allowed patients to rate their satisfaction on graduated scales, from “satisfied” to “dissatisfied.” Five articles offered an “undecided” category, and patients who selected this option were not included in the review analysis.
The research team reviewed 19 studies from 13 countries representing the U.S. and most areas of the world, encompassing 2,198 subjects who had LASIK between 1995 and 2003. A comprehensive international literature search performed by a Storm Eye Institute panel had indentified 309 peer-reviewed, well-designed studies of primary (original) LASIK surgery, of which 19 reported on both patient quality of life and satisfaction. All were randomized, controlled clinical trials, or cohort or case-controlled studies.
Inhaled and Oral Steroid Use Impacts Cataract Risk
A study conducted by the Centre for Vision Research, University of Sydney, Australia, examines how steroid (corticosteroid) use relates to risks for cataract, the clouding of the eye’s lens that leads to reduced vision and blindness, if untreated. Many people with asthma rely on inhaled, and sometimes oral, steroids, as do people with chronic obstructive pulmonary disease (COPD). This population-based study, a cohort of the Blue Mountains Eye Study, followed 3,654 Australians, aged 49 years or older, five and 10 years after initial (baseline) examinations conducted between 1992 and 1994. This timeframe was needed to assess the long-term impact of steroid use on cataracts, which develop slowly over years. Based on their findings, the researchers suggest that more judicious prescription of combined inhaled and oral steroids may decrease cataract risk for asthma patients.
“Our findings could mean that combined steroid use, when it results in high cumulative dosage over relatively long periods, increases risks for two types of cataract,” said lead researcher, Jie Jin Wang, MMed, PhD, Centre for Vision Research. “When clinicians prescribe both steroid forms, the cumulative, combined dose should be considered. Also, recent clinical trials indicate that combined steroids are not more effective than inhaled steroids alone in treating asthma.” He added that further investigation is needed to determine whether asthma plays a role in nuclear cataract development.
Elevated cataract risks were found only in patients who, at the time of their baseline exams, had ever used inhaled steroids, had also used oral steroids for at least one month, and had no cataracts. Patients at highest risk for two types of cataract were those defined at baseline as “current users” of both steroid forms; although this was a small group, follow up exams found that nearly all of them developed cataracts. Of seven current user patients, five had used either steroid form for more than five years, and four of the five developed posterior subcapsular cataract (PSC). Three additional current user patients developed nuclear cataracts. In nuclear cataracts the center of the lens is obscured, and in PSC the cataract develops in the rear area of the lens. Earlier research had established a higher risk for PSC in oral steroids users.
First Large Study of Preschool Children’s Vision Finds Need for Improved Care
This new report on an element of the Baltimore Pediatric Eye Disease Study (BPEDS) provides the first population-based data on refractive error and the need for vision correction in American preschool-aged children. Researchers tested 2,546 African-American and non-Hispanic white children for nearsightedness, farsightedness and astigmatism. BPEDS was conducted between 2003 and 2007 in the urban area in and around Baltimore, Maryland. Like school-aged children, very young children who have undetected, uncorrected refractive errors are at risk for a number of visual disorders including amblyopia, in which vision in one eye is weaker than the other, and strabismus, in which one eye does not align properly. If children with a high degree of farsightedness do not receive vision correction, strabismus can result. Most often the disorder can be corrected if eyeglasses are prescribed.
The study found that 5.1 percent of participating children had refractive errors that would benefit from prescription eyeglasses, based on current correction standards for this age range. Also, 10 of 29 children who had been prescribed glasses prior to their BPEDS exams were found not to need glasses. Farsightedness was the most common refractive error among both African-Americans (4.4 percent) and white children (8.9 percent); these rates did not change significantly as the children aged.
“The unmet need for refractive correction plus the prescription of unnecessary glasses for some children suggest that the quality of eye care for children in the Baltimore urban area needs to be improved,” said David S. Friedman, MD, MPH, PhD, the Wilmer Eye Institute, Johns Hopkins School of Medicine, who led the study. In 2008 Maryland passed a law intended to improve vision screening of school-age children; the preschool age group was not addressed by this law.
About the American Academy of Ophthalmology
AAO is the world’s largest association of eye physicians and surgeons – Eye M.D.s – with more than 27,000 members worldwide. Eye health care is provided by the three “O’s” – opticians, optometrists and ophthalmologists. It is the ophthalmologist, or Eye M.D., who can treat it all: eye diseases and injuries, and perform eye surgery.
American Academy of Ophthalmology