ASCRS News: EyeWorld Journal Club
April 2023
by Daniel Lee, MD, Adam Hanif, MD, Ashlin Joye, DO, Kaitlin Kogachi, MD, Claire Mueller, MD, Daniel Tu, MD, PhD
Oregon Health & Science University, Casey Eye Institute ophthalmology residents
Presbyopia is an age-related visual phenomenon that results in gradual difficulty with near and intermediate vision tasks.1 Several interventions have been introduced to address presbyopia, including the introduction of presbyopic IOLs, which can be implanted after removal of either a cataract or a clear crystallinelens.2 Prior reports suggest that factors related to patient personality are just as important to perceived surgical success and postoperative satisfaction as other more objective clinical measures.3 Ntonti et al. sought to better understand the impact of patient personality on both the IOL selection process and the postoperative satisfaction of patients who underwent pseudophakic presbyopic correction.4
Methods
Participants for this prospective observational study were recruited from the University Hospital of Alexandroupolis in Greece. Eligible subjects required a diagnosis of Lens Opacities Classification System II stage bilateral senile cataracts and the use of near vision spectacles for at least 2 years prior to their initial visit. Subjects were excluded if they had a diagnosis of age-related macular degeneration, glaucoma, corneal surface disease, prior eye surgery, manifest astigmatism <0.50 diopters, mesopic pupil diameter <4.8 mm, chord-mu <0.4 mm, and coma below 0.32 um. An independent researcher provided eligible patients with information about cataract surgery, prior outcomes reported by this study group, and video simulation of various dysphotopic phenomena. Participants were offered the option of bilateral trifocal correction (PanOptix IOL, Alcon) or bilateral mini-monovision monofocal correction (AcrySof IOL, Alcon) with no difference in cost. Participants responded to the Traits Personality Questionnaire 5 (TPQue5) during their initial consultation and subsequently completed the Greek version of the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) 6 months after the operation of the second eye. All operations were performed by the same surgeon. The subjects who underwent bilateral trifocal correction were subdivided into three groups based on their postoperative satisfaction. The impact of personality on the IOL selection process as well as postoperative satisfaction was assessed using data modeling with decision trees and multiple regression analysis.
Results
Of the 120 participants (60 men and 60 women), 81 participants (67.5%; 24 men, 57 women) chose bilateral trifocal IOL implantation. Those who chose the trifocal IOL option were significantly younger than those who chose the monofocal IOL option (p=0.04).
In men, low neuroticism and high extraversion were the primary characteristics associated with selection of the trifocal IOL option. In women, all personality traits appeared to contribute to the selection process. While a postoperative uncorrected distance visual acuity (UDVA) better than 0.1 logMAR resulted in maximal satisfaction in both men and women, women were less satisfied with postoperative UDVA worse than 0.1 logMAR; men were fairly satisfied unless their postoperative UDVA was worse than 0.3 logMAR. Uncorrected near visual acuity (UNVA) outcomes were similar between men and women, both requiring below 0.1 logMAR for high satisfaction rates. Of the subjects who underwent trifocal IOL implantation, multiple regression analysis revealed characteristics associated with higher postoperative satisfaction, which included openness to experience, conscientiousness, and extraversion. Low openness to experience in combination with high neuroticism was found to be more associated with low satisfaction.
Source: Casey Eye Institute
Discussion
Though many pharmacologic and surgical options exist to address presbyopia, every option has its limitations. To date, no technology can entirely restore vision to a pre-presbyopic state. Thus, preoperative counseling to set patient expectations is arguably just as important as the procedure itself, and careful patient selection for premium IOL implantation is paramount to optimize postoperative satisfaction. This study revealed personality traits that may help predict premium IOL selection and satisfaction. For men, neuroticism and extraversion were key characteristics associated with the selection of a premium IOL. For women, the decision tree appeared more complex; interestingly, only three women self-selected into the control (monofocal IOL) group, making interpretation of IOL selection characteristics of women in this study challenging. This study suggests that a favorable patient profile associated with greater postoperative satisfaction after trifocal IOL implantation is one with higher levels of openness to experience in conjunction with high conscientiousness and extraversion. This study may not be entirely generalizable as there was careful selection of patient optical characteristics, and the typical out-of-pocket costs associated with premium IOL options were circumvented.
Impact of personality on the decision process and on satisfaction rates in pseudophakic presbyopic correction
Ntonti P, et al. J Cataract Refract Surg. 2022;48:1433–1439.
- Purpose: Primary objective of this paper is to explore the impact of personality οn the decision process and the satisfaction rates in pseudophakic presbyopic correction.
- Setting: Department of Ophthalmology, University Hospital of Alexandroupolis, Greece.
- Design: Prospective, comparative study.
- Methods: A consistent consultation was conducted in cataract patients that explained the benefits and the drawbacks of bilateral trifocal correction, which was offered at no extra cost. In all participants, personality was evaluated by the Traits Personality Questionnaire 5. Data modeling with decision trees and multiple regression analysis identified the contributions of personality traits in the decision process and the postoperative satisfaction.
- Results: Of 120 participants (60 men and 60 women), 81 (67.5%, 24 men, 57 women) selected premium correction. In men, low neuroticism and high extraversion were the primary personality contributors for selecting premium surgery. In women all personality traits contributed to the selection process. Women were more demanding in the expected postoperative distant acuity than men (0.1 vs 0.2 logMAR) in order to present high satisfaction. For both men and women, openness to experience, conscientiousness and extraversion are primary contributors for optimal satisfaction rates.
- Conclusion: Men and women demonstrate differences in the selection process for premium pseudophakic surgery and differences in the expected postoperative visual acuity. It seems that the personality of the patient plays a significant role in the perceived outcome following premium surgery.
References
- Holden BA, et al. Global vision impairment due to uncorrected presbyopia. Arch Ophthalmol. 2008;126:1731–1739.
- Labiris G, et al. Mini-monovision versus multifocal intraocular lens implantation. J Cataract Refract Surg. 2015;41:53–57.
- Rudalevicius P, et al. Relations between patient personality and patients’ dissatisfaction after multifocal intraocular lens implantation: clinical study based on the five factor inventory personality evaluation. Eye (Lond). 2020;34:717–724.
- Ntonti P, et al. Impact of personality on the decision process and on satisfaction rates in pseudophakic presbyopic correction. J Cataract Refract Surg. 2022;48:1433–1439.
Contact
Lee: leedani@ohsu.edu
Tu: tu@ohsu.edu
