Happy Patient Project - PowerPoint Presentation

Slide1

Happy Patient Project

clinical and psychometric results2011

ESCRS 2011Slide2

Impact of personality characteristics on satisfaction after multifocal IOL-implantation – the “Happy Patient Study”

Financial Disclosure:

No author has a financial or proprietary interest in any material or method mentioned.

Introduction:

At the present the implantation of bi- or multifocal intraocular lenses (MIOL) is the best established method to gain spectacle independence after cataract surgery.

Many investigations reveal a percentage of more than 80% of patients being satisfied after MIO-implantation without need for any glasses (1,2,3,5,6,7).Patient’s satisfaction depends on a myriad of factors as optic design of the MIOL, near addition, light transmittance, characteristics, pupil diameter, and the visual needs of each individual patient for far, intermediate, and near distances.Clinical studies with MIOL`s of different optic designs (refractive, diffractive, hybrid) showed comparable results with small percentage of unsatisfied patients. (Authors).Dissatisfaction in these patients is often not correlated to the objective visual outcome.Why do some patients report not to profit from multifocal lenses and/or to suffer seriously from side effects as halos and glare without objective findings which could explain these subjective intolerance?The postoperative exploration of these patients let to the consideration that there may be individual personality characteristics which make the difference between objective findings and subjective feelings.We therefore performed a prospective multicentre study to investigate possible personality factors which would enable us to select the good candidates to become “Happy Patients”.Patients and methods: Study Group and ProtocolIn a prospective study, patients with bilateral MIOL-implantation were enrolled in 8 European ophthalmological centres. According to statistical needs a minimal number of 150 patients had to be included without restriction for recruitment in each centre. Inclusion criteria were bilateral implantation of MIOL in eyes without pathological findings except cataract, not more than 1.5 D astigmatism, informed consent of the study protocol, and patients being able and willing to answer the study questions preoperatively and at two control visits, three and six months after surgery of the second eye. Another major inclusion criterion was patient’s motivation for spectacle independence.Ophthalmological data and questionnaires where send to and evaluated by an independent reading centre (T.V.).Intraocular LensesEach centre was free to choose the MIOL´s of it`s own preference. The following lenses where implanted: Tecnis ZM900 (29%), Tecnis ZMA00 (26%) (AMO), ReSTOR+4 (21%), ReSTOR+3 (10%) (Alcon), AcriLisa (4%) (Zeiss).

Ulrich Mester, MD, Frank Goes MD, Werner Huetz MD, Thomas Neuhann MD, Stefanie Schmickler MD, Peter Szurman MD, Thomas Vaterrodt, MD Corresponding author: Ulrich Mester, MD, Augenzentrum im Medizeum, Europaallee 15, 66113 Saarbruecken, Germany, email: prof.mester@email.de

ESCRS 2011Slide3

Table 2: Distribution of the different MIOL models on right and left eyes

OD

OS

Tecnis ZM900

ReZoom

Tecnis ZMA00

ReSTOR+4

AcriLisa

ReSTOR+3

Tecnis ZM9002318102ReZoom1312Tecnis ZMA001235ReSTOR+4237AcriLisa8ReSTOR+320

ESCRS 2011Slide4

Table 3: Visual performance of activities in different distances 3 months after surgery.

 n=163

Near (e.g.reading)

Intermediate (e.g.computer work)

Far (e.g.TV)

easy

85%

62%

85%

difficult9%26%12%Not able without glasses6%12%3%ESCRS 2011Slide5

The general satisfaction after MIOL implantation was high: 82.2% would decide again for this procedure, only 3.7% would not, 14.1% were uncertain at the 3-months control. These results were nearly unchanged after 6-months (82.5%, 2.8%, and 14.8%).

A more detailed presentation of the degree of satisfaction is shown in figure 3. Obviously, the percentage of patients being satisfied or completely satisfied increases from 3 to 6-months after surgery wereas the group of only moderately satisfied patients decreases. The small unsatisfied group of patients remains constant. There was no significantly difference between females and males.

Out of 23 patients being unsatisfied or only moderately satisfied 11 patients were completely spectacle independent. One patient was unsatisfied and 10 patients were moderately unsatisfied with their visual performance. One patient reported on severe, five of strong, and five of moderate glare. The impact of halos was described as severe by two, as strong by three, and as moderate by six patients. Reduced vision under mesopic conditions was severe in one patient, strong in one patient and moderate in four patients.

ESCRS 2011Slide6

N=183

%

No personality disorder

9

self-discipline

5

orderliness

29

deliberation

29achievement striving38competence44dutifulness51compulsive checking60. Table 4: Pronounced personality characteristics evaluated by the psychometric testsESCRS 2011Slide7

Table 5: Correlation of postoperative satisfaction with data other than psychometric

(no difference at the two observation periods).

Correlation with postoperative satisfaction

Significance

Gender

n.s

Preoperative expectations and accepted limitations

n.s

Less postoperative cylinder <0.05Spectacle independence distance<0.01Spectacle independence near<0.05God vision in different distances and different lighting conditions< 0.01Less bothering by side effects as photic phenomena GlareHalos< 0.01< 0.05Less blurred visionNear Distance< 0.01< 0.01Less problems under mesopic conditions < 0.01More activities without spectacles< 0.01ESCRS 2011Slide8

Table 6: Correlation of psychometric characteristics with postoperative side effects, visual function, and satisfaction.

Correlation with psychometric data

Significance

Compulsive checking

Glare

Halos

Stereo vision

Distance vision

< 0.05< 0.01< 0.01< 0.05Orderliness GlareHalosStereo visionMesopic vision< 0.01< 0.05< 0.05< 0.05CompetenceGlareHalosPostoperative satisfaction< 0.05< 0.05 < 0.01DutifulnessHalosStereo vision< 0.05< 0.05achievement strivingdeliberationself-disciplinen.sESCRS 2011Slide9

Conclusion:

Individual personality disorders does significantly influence the tolerance of side effects and patients satisfaction after MIOL implantation. Therefore a preoperative evaluation of psychometric data may help to get more ´Happy patients`.

The results of these study can be used to concentrate such a manual on the most relevant questions.

ESCRS 2011Slide10

The “New Happy Patient” questionaire

female

male

Age

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

I’m known for my prudence and common senseI would rather keep my options than plan everything in advanceI try to perform all the tasks assigned to me conscientiouslyI don’t take civic duties like voting seriouslyI keep my belongings neat and cleanSometimes I’m not dependable or reliable as I should be

I keep myself up-to-date and usually make clever decisions

I am not a very methodical person

I pay my debts promptly and in full

I often come into situations without being fully prepared

I like to keep everything in its place so I know just where it is

Sometimes I cheat when I am playing card games on my own

I pride myself on my sound judgement

I never seem to be able to get organized

When I make a commitment, I can always be counted on to follow through

Before I know what I want I need to think it through

I check things several times to be on the safe side

I repeat activities frequently until I am happy with it

Some thoughts don’t get out of my mind

I always need to check once more if I have closed the door properly

ESCRS 2011Slide11

The “New Happy Patient” questionaire

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

I’m known for my prudence and common sense

I would rather keep my options than plan everything in advance

I try to perform all the tasks assigned to me conscientiously

I don’t take civic duties like voting seriouslyI keep my belongings neat and cleanSometimes I’m not dependable or reliable as I should beI keep myself up-to-date and usually make clever decisionsI am not a very methodical person

I pay my debts promptly and in full

I often come into situations without being fully prepared

I like to keep everything in its place so I know just where it is

Sometimes I cheat when I am playing card games on my own

I pride myself on my sound judgement

I never seem to be able to get organized

When I make a commitment, I can always be counted on to follow through

Before I know what I want I need to think it through

I check things several times to be on the safe side

I repeat activities frequently until I am happy with it

Some thoughts don’t get out of my mind

I always need to check once more if I have closed the door properly

ESCRS 2011Slide12

Thank you for your attention

ESCRS 2011