Retina
January 2009
by Vanessa Caceres
EyeWorld Contributing Editor
Contrast sensitivity affects patients’ quality of life
Patients may view their quality of life negatively after retinal detachment surgery even if surgical outcomes are good, a new study concludes. The negative perception of quality of life is significantly associated with a deterioration of post-op contrast sensitivity, the investigators wrote.
The study was led by Fumiki Okamoto, M.D., department of ophthalmology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan, and was published in the July 2008 issue of the American Journal of Ophthalmology.
To the investigators’ knowledge, this is the first quality of life study in retinal detachment patients.
“Because retinal detachment is an acute-onset, unstable, and progressive disease, it is difficult to evaluate pre-operative visual function quality of life in patients. However, assessment of post-operative daily activities and well-being of patients after retinal detachment surgery are feasible and of clinical importance,” investigators wrote.
Source: Anand Sudhulkar, M.D.
Study details
The study included 51 eyes from 51 patients who had a retinal detachment and were treated successfully with either a scleral buckling procedure or pars plana vitrectomy between January 2006 and February 2007. The study included 38 males and 13 females with a mean age of 51.9 years. Patients with a previous history of ocular surgery in the operated eye, other ophthalmic disorders, and complicated vitreoretinal disease such as proliferative vitreoretinopathy were not included. Investigators compared data from the retina detachment patients with a group of 46 normal controls.
Six months after surgery, the investigators measured logMAR best-corrected visual acuity (BCVA) and contrast sensitivity. Contrast sensitivity was tested with a CSV-1000E chart and a CSV-1000LanC10% chart (VectorVision, Greenville, Ohio).
Patients completed the 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) at six months post-op. Research staff helped patients complete the questionnaire, which asked patients to rate the difficulty they had with specific visual symptoms or vision-related daily activities. The VFQ-25 measures symptoms and activities under 12 scales: general health, general vision, ocular pain, near activities, distance activities, social functioning, mental health, role difficulties, dependency, driving, color vision, and peripheral vision. A score of 0 to 100 is possible within each scale, with a higher score indicating a better quality of life within a particular area. There is also a final composite score.
What the results showed
Retinal reattachment was successful after one operation in all eyes, and there were no significant intra-op or post-op complications. Sulfur hexafluoride (SF6) gas was injected in 22.2% of the scleral buckling patients and 20% of the vitrectomy patients. Subretinal fluid drainage was performed in 50% of patients. No patients had cataract formation. At six months post-op, the mean logMAR BCVA was 0.06, the mean log contrast sensitivity function was 0.97, and the mean low-contrast visual acuity was 0.50.
Comparing VFQ-25 results, composite scores were lower in the retinal detachment patient group (mean, 80.3) compared with normal controls (mean, 85.2). “The retinal detachment group showed significantly lower scores than the normal controls in four subscales: near activities, mental health, dependency, and peripheral vision,” the investigators wrote. Investigators did not find a correlation between the VFQ-25 composite score and the post-op logMAR BCVA, but they did find a significant correlation between the log contrast sensitivity function and low contrast visual acuity.
They also had significantly lower scores compared with normal controls for near activities, mental health, dependency, and peripheral vision.
“Although visual acuity in the retinal detachment patients was almost normal after reattachment surgery, their vision related quality of life was found to be deteriorated,” investigators wrote. The mean composite score of 80.3 is comparable to quality of life scores in patients after epiretinal membrane surgery (mean, 82.4) and after macular hole (mean, 83.3), they wrote.
Ophthalmologists may commonly use visual acuity to informally gauge a patient’s quality of life after surgery, but contrast sensitivity seems to have an even stronger correlation, according to the study results.
“Contrast sensitivity has been shown to correlate with various aspects of activities requiring vision, including orientation, mobility, reading speed, and driving,” investigators wrote.
Implications
The study gives a unique glimpse into what patients experience after retinal detachment surgery, physicians said.
“I think it is a well-done study that demonstrates that loss of contrast sensitivity despite successful retinal detachment repair can negatively impact quality of life,” said Paul S. Bernstein, M.D., Ph.D., Mary Boesche Professor of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City.
Despite what the scores show, the study does not show the whole picture of life post-surgery, he added.
“This study fails to capture some of the positive impact of retinal detachment repair. Even if the visual outcome is less than optimal, retinal detachment patients are among my most appreciative patients. Often they have suffered sudden unexpected visual loss as a dark curtain relentlessly progresses across their visual field,” Dr. Bernstein said. While Hyong Kwon Kang, M.D., Eye Unit, Southampton University Hospital NHS Trust, Hampshire, United Kingdom, agrees that the study directs needed attention to quality of life, he would like to know what may be responsible for patients’ loss of contrast sensitivity, especially considering the study did not report on any cataract formation after vitrectomy and the use of gas tamponade.
Dr. Kang also said that the decreased quality of life is not entirely related to visual problems.
“Of the four quality of life parameters found to differ significantly [from the controls], mental health and dependency are not entirely visual in scope. The threat of vision loss, stress of the treatment, fear of the future, and the need to adapt to the change in visual function has psychological and social implications that are measurable by the VFQ-25,” he said. Further study in a larger group of patients over a longer period of time could help support the findings reported, the investigators concluded.
Editors’ note
Drs. Bernstein and Kang have no financial interests related to their comments.
Contact information
Bernstein: 801-581-6078, paul.bernstein@hsc.utah.edu
Kang: kwonkang@ozemail.com.au
