Quality of Life Assessment after Femtosecond Laser-Assisted Keratoplasty

1. Quality of Life Assessment after Femtosecond Laser-Assisted Keratoplasty Jessica Knowlton BS, Satavisha Dutta MS, Roni Shtein MD, Alan Sugar MD, Shahzad Mian MD Authors have no financial interest. Supported by unrestricted grants from Fight for Sight, Midwest Eye-Banks, Research to Prevent Blindness, Michigan Institute for Clinical and Health Research New Pilot Clinical Training Grant NIH grant #1RO1-EY014163-01A1 ID 853

2. Abstract • Purpose: To determine vision-related quality of life after Femtosecond Laser-Assisted Keratoplasty (FLAK) • Methods: Prospective, consecutive case series of patients undergoing FLAK receiving the NEI VFQ-25 in order to assess vision quality of life before and 6, 12 and 18 months after surgery. Items were scored using composite score calculation methods and sub-scale groupings. Statistical significance for composite scores and sub-scale grouping scores was determined using the Student’s t-test two sample analysis with unequal variances. • Results: Twenty-two eyes of 22 patients with a mean follow-up of 10.8 months were enrolled in the study. The composite score was significantly increased at six months (p=0.03) and one year (p=0.02) after surgery. There was significant improvement in the major sight-related scores (p<0.005): general vision, near activities, distance activities, social functioning, and peripheral vision. There was also a significant improvement (p<0.05) in the general health, ocular pain, mental health, role difficulties, dependency and driving sub-scale scores. • Conclusions: Femtosecond laser-assisted keratoplasty provides significant improvement in the quality of life of patients six months and one year after surgery.

3. Background • Penetrating keratoplasty (PKP) has a high success rate in terms of graft survival and visual acuity1 • Limited by high astigmatism and refractive instability2 • Femtosecond laser-assisted keratoplasty (FLAK) reduces graft-host disparity with subsequent reduction in topographic distortions3 • Potential for faster wound healing with earlier suture removal • Vision related quality of life limited after PKP4

4. To determine vision-related quality of life measured with the National Eye Institute Visual Function Questionnaire (NEI-VFQ) in patients undergoing femtosecond laser-assisted keratoplasty (FLAK). Purpose

5. Methods • Prospective, consecutive case series of 22 eyes of 22 patients undergoing mushroom-shaped FLAK with mean follow-up of 10.6 months. • Inclusion criteria: age ≥18 yrs, corneal opacification, and BCVA ≤20/40 in the affected eye. • NEI-VFQ-25 performed preoperatively and at 6, 12 and 18 months postoperatively.

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10. Discussion When comparing NEI-VFQ scores after FLAK (n=8 at 1 year) and standard PKP (graft age <5 years, n=39), general health, general vision, ocular pain, near and distance activities, social functioning and peripheral vision had higher scores (bold).

11. Conclusions • Vision quality of life improves after FLAK up to 18 months postoperatively. • When compared to historical PKP scores, FLAK may provide greater improvement in vision quality of life. • Further study is needed to better assess quality of life improvement after FLAK and to compare outcomes with PKP.

12. Bibliography • Council on Scientific Affairs. Report on the organ transplant panel: corneal transplantation. JAMA. 1988;259:719-22. • Hoppenreijs, VPT. et al. Causes of high astigmatism after penetrating keratoplasty. Documenta Ophthalmologica 1993; 85: 21-34. • BaptistaMalta‌, J. et al. Femtosecond Laser-Assisted Keratoplasty: Laboratory Studies in Eye Bank Eyes. Current Eye Research. 2009;34: 18-25. • Kymes, SM, et al. Quality of Life in Keratoconus. American Journal of Ophthalmology. 2004;138:527-35. • E. Yildiz, et. al. Quality of Life in Keratoconus Patients After Penetrating Keratoplasty. American Journal of Ophthalmology 2010; 149:416-22.