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Neel Dave Pasricha, Stephen Hannan, Steve Schallhorn, Julie Schallhorn; Biases in patient-reported outcomes after laser vision correction. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5748.
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The need for studying patient-reported outcomes (PRO) in laser vision correction (LVC) is widely acknowledged and thus participation of LVC patients in questionnaires is important. However, there may be a reporting bias in the patients that choose to answer the questionnaire versus those that do not. To learn about these potential biases, we undertook an analysis of demographics and visual outcomes between LVC patients who did and did not complete the questionnaire.
All patients undergoing LVC with photorefractive keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK), between January 1, 2014 and December 31, 2016 at a private refractive surgery center (Optical Express, Glasgow, UK) were included in this study. All patients were offered a visual symptoms and satisfaction questionnaire based on the Patient-Reported Outcomes with LASIK (PROWL) questionnaire at their preoperative and 3 month postoperative visits. Patient demographics and clinical outcomes were compared between LVC patients who completed versus those who did not complete the questionnaire at both time intervals using chi-squared tests for categorical data and two-tailed t-tests for continuous data.
A total of 36,937 LVC patients were identified, out of which 6,033 (16.3%) completed both the preoperative and postoperative month 3 questionnaires. Patients completing the questionnaires were statistically significantly (all p<0.01) more likely to be older (35.7±11.4 vs 33.8±10.2 years), female (53.9% female vs 47.9% male), hyperopes (15.0% vs 10.3%), have worse preoperative visual acuity (-3.17±2.05 vs -2.87±1.89 for myopes; +1.83±0.99 vs +1.69±1.01 for hyperopes), and have worse postoperative visual acuity outcomes (83.6% vs 87.7% 20/20 or better).
Our results show a statistically significant difference in patient demographics and visual outcomes between LVC patients who completed versus those that did not complete the PRO questionnaire. Interestingly, patients completing the questionnaire had higher preoperative ametropia and worse postoperative visual outcomes. These biases may affect the validity of questionnaire results when applied to the population as a whole. Understanding these biases is important in interpreting results from PRO questionnaires. Further research is needed to determine why questionnaire completion biases exist and how to best overcome them.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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