Abstract
Purpose :
The aim of this study was to evaluate the rate at which patients with low vision (LV) from cornea diseases were referred for LV services and to assess the visual outcomes from completed evaluations.
Methods :
The study comprised a one-year retrospective, cross-sectional study of patients who had corneal diseases resulting in a visual acuity (VA) of 20/40 or worse in the better-seeing eye. Patients with comorbidities that impacted vision, such as glaucoma or retinal disorders were excluded from the analysis. Documented referrals for LV evaluation were abstracted from the electronic record. Treatment effectiveness was determined by comparing the presenting VA with the best-corrected visual acuity after distance refraction. Costs, quality-adjusted life years (QALYs), and incremental costs per QALY gained in the better-seeing eye were calculated using a willingness-to-pay threshold of USD 50,000/QALY.
Results :
Of 3230 patients, 143 (4.4%) had vision impairment primarily due to a corneal condition. Among them, LV was identified in 19 cases (13%). In total, 76 patients (53%) were referred for an LV evaluation, and most of those referred completed LV appointments (96%). Patients referred tended to be younger (73.7 years vs. 79.2 years, p=0.055), to have better VA in their worse-seeing eye (0.96 LogMAR vs. 1.45 LogMAR, p=0.002), and were employed (64% vs. 40%, p=0.004). The conditions more likely to be referred included corneal dystrophies, degenerations, and ectatic conditions (51% vs. 27%, p=0.003) or immunologic conditions (13% vs. 2.6%, p=0.016). Patients gained an average of ΔLogMAR -0.13 in their better- and ΔLogMAR -0.38 in their worse-seeing eyes after LV refraction. This led to a sufficient improvement for 9 out of 11 cases to no longer be classified as LV (82%). In total, more than half of patients achieved improved VA in their better-seeing eye (63%), with 30% gaining ≥2 lines of VA. This improvement in VA yielded an average gain of 0.04 QALYs/patient at a cost of USD 3128/QALY. The estimated net monetary benefit was USD 1923 per evaluation completed.
Conclusions :
The study highlights the importance of LV services for patients with corneal diseases, demonstrating significant visual improvements and cost-effectiveness in those referred for evaluation. Further efforts are needed to improve the rate at which patients with corneal diseases access LV services.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.