SIGNIFICANCEThis review has identified the best existing patient-reported outcome (PRO) instruments in refractive error. The article highlights the limitations of the existing instruments and discusses the way forward.PURPOSEA systematic review was conducted to identify the types of PROs used in ref

Patient-reported Outcomes for Assessment of Quality of Life in Refractive Error: A Systematic Review.

Purpose: The aim of this study was to explore the impact of corrected and uncorrected refractive error (URE) on Nepalese people’s quality of life (QoL), and to compare the QoL status between refractive error subgroups.Methods: Participants were recruited from Tilganga Institute of Ophthalmology and Dhulikhel Hospital, Nepal. Semi-structured in-depth interviews were conducted with 101 people with refractive error. Thematic analysis was used with matrices produced to compare the occurrence of themes and categories across participants. Themes were identified using an inductive approach.Results: Seven major themes emerged that determined refractive error-specific QoL: activity limitation, inconvenience, health concerns, psycho-social impact, economic impact, general and ocular comfort symptoms, and visual symptoms. Activity limitation, economic impact, and symptoms were the most important themes for the participants with URE, whereas inconvenience associated with wearing glasses was the most important...

Uncorrected and corrected refractive error experiences of Nepalese adults: a qualitative study

Significance Existing patient-reported outcome instruments in refractive error are paper-based questionnaires. They are not comprehensive and psychometrically robust. This study has identified the content of the refractive error-specific item banks that aim to provide comprehensive and scientific measurement of refractive error-specific quality of life. Purpose The purpose of this study was to identify minimally representative, optimally informative, and efficient sets of items for measuring quality of life in people with refractive error. Methods First, items were identified from existing patient-reported outcome instruments. Second, items were developed from qualitative studies with people with refractive error (48 and 101 in-depth interviews in Australia and Nepal, respectively). Third, classification and selection of items were done based on a set of systematic criteria using an iterative process of binning and winnowing. The resulting items underwent cognitive testing with people with refractive error in Australia and in Nepal. Each step was guided by an expert panel consensus. Results We retrieved 792 items from the existing patient-reported outcome instruments. From the interviews conducted in Australia, a total of 2367 comments were coded into 807 initial items. Similarly, from the interviews conducted in Nepal, 3477 comments were coded into 914 initial items. After binning and winnowing, followed by cognitive testing, a final set of items comprising 337 items for the Item-pool (Australia) and 308 items for the Item-pool (Nepal), both spanning 12 domains, was obtained. Forty-seven percent of items were common across the two item pools. In the Item-pool (Nepal), 65% items were common for corrected and uncorrected refractive error. Conclusions We identified the content of two different sets of item banks to comprehensively measure the impact of refractive error on quality of life for people in Australia and Nepal, which may be applicable to high-income country settings and low- and middle-income country settings, respectively. Future work aims to develop computer-adaptive testing system to administer the item banks, resulting in useful measurement tools for researchers, clinicians, and policy planners.

Constructing Item Banks for Measuring Quality of Life in Refractive Error.

RESULTS. Study 1: Inflammatory cell infiltration in the central cornea was significantly greater in the FS group than in the MM group at 4 and 24 hours (P 0.05) and was significantly greater in the FSLASIK group than in the MMLASIK group at 24 hours (P 0.05). Infiltration at the peripheral interface was significantly greater in the FS group than in the MM group and was significantly greater in the FSLASIK group than in the MMLASIK group at 24 hours (P 0.05). Study 2: At 1 and 3 months, 126.7 and 191.3 grams of force (gf) were needed to detach the flaps in the FS group, compared with 65 and 127.5 gf in the MM group, respectively. The grams of force needed was significantly higher in the FS group than in the MM group at 3 months (P 0.05). CONCLUSIONS. The FS laser produces greater corneal stromal inflammation than the MM early postoperatively without any increase in apoptosis and stronger flap adhesion late postoperatively. Therefore, it may require stronger anti-inflammatory drugs to be administered. (Invest Ophthalmol Vis Sci. 2006;47: 599‐604) DOI:10.1167/iovs.05-0458

https://ir.ymlib.yonsei.ac.kr/bitstream/22282913/111049/1/T200604781.pdf

A Femtosecond Laser Creates a Stronger Flap than a Mechanical Microkeratome

The role of corneo-scleral junction in soft contact lens fitting: Case report on nanophthalmos.

Purpose : Although refractive error is the commonest ocular abnormality and the commonest cause of global visual impairment, qualitative studies exploring the impact of refractive error in people’s lives are sparse. This study was therefore carried out to explore the impact of refractive error on quality of life. Methods : We conducted 101 semi-structured in-depth interviews with people having refractive error, with or without corrections. Purposive sampling was applied to capture issues of people with diverse spectrum of refractive error. The interviews were recorded, transcribed and analysed using NVivo Software, Version 11 (QSR International Pty Ltd.). The thematic analysis was done using both inductive and deductive processes. We compared quality of life issues among people with various types of refractive error and among people with di erent refractive corrections. Results : The median age of the participants was 29 (range: 18 to 74) years. More than half were male (n=55) and myopes (n = 56). Almost one fth were surgical emmetropes (n = 19). Twenty-nine participants had presbyopia. Nearly half of the participants (n = 47) had uncorrected refractive error. In regards to the refractive correction, sixty participants used glasses to varying frequency. Similarly 20 had surgical correction and 17 used contact lenses. During thematic analysis, 3,477 comments were coded into 381 nodes under 8 broad themes: Convenience, Activity limitations, Health concerns, Psychosocial well-being, Economic well-being, Visual symptoms, Ocular comfort-symptoms and General symptoms. Inconveniences wearing glasses was the most important issue in glasses wearers. Whereas, possibilities of having side e ects or complications were the major concerns for participants wearing contact lenses. Similarly, concerns regarding the

Living experiences of people with refractive error: A qualitative study from Nepal

Introduction: Contrast sensitivity function after laser ablation of the cornea in refractive surgery is an important tool for measuring quality of visual function. The effect of small incision lenticule extraction (SMILE) and femtosecond laser in situ keratomileusis (FS-LASIK) on visual function can be compared by measuring spatial contrast sensitivity.
Purpose: This study was to compare contrast sensitivity function in patients undergoing refractive surgery for myopia at Tilganga Institute of Ophthalmology.
Methods: In a retrospective study, 15 subjects who underwent refractive surgeries comprising 9 cases of SMILE and 6 cases of FS-LASIK at Tilganga Eye Hospital were enrolled in the study. A major assessment included best corrected monocular contrast sensitivity with functional vision analyzer at spatial frequencies of 1.5, 3, 6, 12, and 18 cycles/deg in photopic condition (85 cd/m2) before, 3 months, and 1 year after the surgery. The average functional acuity contrast test scores for each spatial frequency were recorded. Differences between preoperative and postoperative contrast sensitivity at each spatial frequency were analyzed through parametric paired Student’s t-test.
Results: Contrast sensitivity of postoperative FS-LASIK and SMILE did not differ from preoperative values at a photopic level. However, at high spatial frequency (12 and 18 cycles/deg), contrast sensitivity function improved significantly (p < 0.05) in eyes after FS-LASIK. Eyes after SMILE surgery did not show any reduction in contrast sensitivity at all the spatial frequencies.
Conclusion: Under photopic conditions, the contrast sensitivity function is unaffected by SMILE or FS-LASIK.

/pdf/contrast-sensitivity-before-and-after-small-incision-9s8up5015z.pdf

Contrast sensitivity before and after small incision lenticule extraction and femtosecond laser in situ keratomileusis

Background: Nanophthalmos is an uncommon developmental ocular disorder characterized by a small eye with short axial length, high hyperopia and high lens to eye volume ratio due to arrested development of the globe in all directions. Different types of fundus changes can rarely occur with nanophthalmos. Observations: This is a case report of a 17 years old female who presented with bilateral gradual progressive visual loss and photophobia at Tilganga Institute of Ophthalmology on 3 rd July 2015. Her best corrected visual acuity was 20/300 with +12.00Ds/-1.00Dcyl@180 in the right eye and 20/200 with +12.00Ds/-1.50Dcyl@180 in the left eye. Axial lengths of two eyes were markedly shortened with pigmentary changes at the macula and dull foveal reflex along with retinal flecks in the mid-periphery. Full field ERG showed diminished rod and cone waves suggestive of rod and cone dysfunction. With the use of Rigid Gas Permeable (RGP) contact lenses, the acuity improved to 20/200 and 20/125 in the right and left eye respectively. Conclusion: This study proposes the use of contact lenses and light absorptive filters for better visual rehabilitation.

/pdf/contact-lenses-for-visual-rehabilitation-in-bilateral-uwnevtk3q3.pdf

Asik Pradhan

Papers

Living experiences of people with refractive error: A qualitative study from Nepal

Contrast sensitivity before and after small incision lenticule extraction and femtosecond laser in situ keratomileusis

Contact lenses for visual rehabilitation in Bilateral Nanophthalmos with Retinal Dystrophy- A case report.