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J. F. S. Paranhos, M. P. Avila, A. Paranhos, Jr., P. Schor; Quality of Vision Evaluation in Highly Aberrated Eyes: A Prospective Study on the Impact of Intracorneal Ring Segments Implantation in 21 Patients With Keratoconus. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4332.
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To prospectively evaluate the outcome of Mediphacos® intracorneal ring segments (ICRS) implantation on quality of life of patients with keratoconus using the NEI-RQL (National Eye Institute Refractive Error Quality of life) instrument.
The questionnaire (NEI-RQL) was administered to patients that had indication for ICRS implantation before surgery and after they were wearing the best correction for at least one month. Refraction and visual acuity data was recorded before and 3 months after surgery.
Twenty one eyes of 21 patients were included in this study. Spherical equivalent (EE) ranged from -16,13D to +0,63D (mean -4,73D +/-4,69) before surgery and from -5,50D to +0,25D(mean -1,96D +/-2,03) after surgery (p=0,01). Best spectacle corrected visual acuity (BSCVA) ranged from 1 to 0,2 log mar (mean 0,43 +/- 0,23) before surgery and from 0,4 to 0 (mean 0,23 +/- 0,15) after surgery (p=0,0016). The BCVA improved in all operated eyes. The mean overall questionnaire scale increased from 33,68 ±16,24 before to 66,04 ±13,60 after surgery (p<0,01). Patients had statiscally significant improvement (p<0,01) in all subscales of NEI-RQL except for worry (p=0,02) and suboptimal correction (p=0,02). The subscales that had less important improvement although statistically significant was appearance (p=0,0083), dependence on correction (p=0,0082), (p=0,007), expectations (p=0,001), ocular symptoms (p=0,0003). Best spectacle corrected visual acuity (p=0,006) and cylinder (p=0,006) presented improvement (although smaller than the overall subscales) but sphere (p=0,09) and spherical equivalent (p=0,02) did not reach statistical significance.
Highly aberrated visual systems are of big problems to be evaluated by traditional optical approaches, as refraction and even visual acuity. Tests as NEI-RQL may be statistically analyzed and in this paper revealed different outcomes that helps explaining patient satisfaction with this technique. We advocate that optical tests be used in conjunction to questionnaires when evaluating human highly aberrated visual systems.
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