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Nicole Ann Carnt, Sophie Connor, Varshini Parayoganathan, Lisa Keay; Predictors of quality of life for Acanthamoeba keratitis patients. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1767. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Acanthamoeba Keratitis (AK) is a severe infection in otherwise healthy contact lens (CL) wearers. Determining predictors of poor quality of life in AK patients can assist in developing coping strategies and better inform clinicians.
This was a prospective case control study of CL associated AK patients and asymptomatic CL wearers. All participants completed the Impact of Vision Impairment (IVI) and RAND 36 Item Health Survey to assess vision related (VR) and general quality of life (QoL) in 8 domains. AK cases were surveyed during active disease and were stratified into bad and good outcomes based on clinical features. AK patients with bad outcomes were defined as having at least one of: Corneal perforation, ocular surgery (except biopsy), duration of anti-amoebic treatment (AAT) of ≥12.6 months (based on 75th percentile) or final VA ≤20/80. IVI was scored with Rasch analysis, and RAND 36 was scored by validated summation (0-100). AK cases were compared to controls and bad outcomes compared to good with Student t tests. VRQoL and QoL were modelled using multivariate linear regression to identify the clinical features of AK that were predictors of poor QoL. Age, gender, presenting disease stage, Herpes Simplex Keratitis (HSK) misdiagnosis, AAT duration, complications, surgical intervention and final VA were considered as predictors.
Seventy-seven AK cases and 83 controls were recruited from Moorfields Eye Hospital and Institute for Optometry, London (mean age 40 ± 16 vs 44 ± 16 years, p=0.8). The median duration of AAT was 209 days (IQR 123-388) and 33% (23/69) were misdiagnosed as HSK. The AK cases had worse VRQoL (mean difference 2.5 logits), and worse QoL scores than controls (6/8 domains, mean difference 7-42, p<0.05). Bad outcome AK patients (33/74, 45%) had worse “physical functioning” (87 vs 94) and “emotional role limitation” (53 vs 74) compared to those with good outcomes (p<0.05). For bad outcome AK patients, AAT duration predicted poor physical functioning (p<0.05), while AAT duration and HSK misdiagnosis were predictors of emotional role limitation (p<0.01).
As well as visual disability, AK patients suffer poor VRQoL and QoL. Misdiagnosis and prolonged treatment are associated with emotional QoL, and long treatment further impacts physical QoL. Clinicians should be aware that support services are likely to be required for these patients.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Scleritis, a painful AK complication
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