‘Happy Patient Program’ looks to standardize multifocal IOL candidate selection

The project is examining connections between patient satisfaction and psychometric parameters in order to improve patient selection for multifocal IOLs.

Frank Goes

Preliminary results of the “Happy Patient Program,” a project aimed at improving and standardizing patient selection for multifocal IOLs, showed a number of correlations between psychometric parameters and patient satisfaction.

“This project has been implemented by an international study group involving several centers in Germany and Belgium with the support of [Abbott Medical Optics]. [The] aim of the study was to evaluate whether a validated psychometric test could help to predict patient satisfaction with multifocal IOLs,” Frank Goes, MD, said at the meeting of the European Society of Cataract and Refractive Surgeons in Paris.

A total of 159 patients eligible for bilateral multifocal IOL implantation were recruited and asked to complete a preoperative psychometric questionnaire including parts of the NEO PI-R Personality Inventory and the Compulsiveness Inventory.

“Patients were questioned about their degree of competence, tidiness, sense of duty, ambition, self-discipline and deliberateness. They were also asked about their expectations concerning vision. The analysis of psychometric tests was carried out by a psychiatrist in our group,” Dr. Goes said.

Preoperative, surgical and postoperative clinical data were recorded in a Web-based registry. Follow-up visits were scheduled at 3 months and 1 year postop. In these visits, patients received routine eye examinations and were asked to complete a questionnaire evaluating overall satisfaction, use of spectacles, performance of various tasks with or without spectacles and impairment in different circumstances.

“We used a variety of multifocal IOLs, including Tecnis ZM900 (AMO), ReZoom (AMO), Acri.Lisa (Carl Zeiss Meditec), ReSTOR (Alcon), Tecnis ZMA00 (AMO) and ReSTOR +3 (Alcon). With all these lenses, visual results were excellent both at distance and near. Photic phenomena were experienced by 20% of the patients, but we were happy to see that none of them could not tolerate them,” Dr. Goes said.

Spectacle use

Spectacle independence was high, with approximately 90% of the cohort not using spectacles for distance, near or intermediate.

“Preoperative psychometric tests were very revealing in terms of expectations,” Dr. Goes said.

When asked for which activities they would accept wearing spectacles, 81% of patients responded that they were willing to wear them to read small print and 61% said they would accept wearing them to do computer work.

Shopping was the activity for which the highest percentage of people (64%) said they would not accept wearing spectacles, followed by driving an automobile (58%).

About 42% of men and 35% of women studied said they would accept some limitation of visual quality, such as glare, halos, reduced contrast sensitivity and reduced night vision, Dr. Goes said.

“Gender differences were significant in quite a few of the answers in our preoperative and postoperative questionnaires,” he said.

Among patients who used spectacles occasionally after surgery, men more frequently required a correction for distance and for reading, while women more often wore spectacles for intermediate vision.

Satisfaction results

Overall satisfaction was almost equally high between men and women, with only a slightly higher score for men.

Satisfaction was high or very high for more than 90% of patients, and for all patients it grew over time, coinciding with the neuroadaptation process. For the majority of patients, however, satisfaction was still lower than expectations.

“Interesting correlations were found between patient satisfaction and aspects of the personality,” Dr. Goes said. “We could document this. A negative correlation was found between satisfaction and control, tidiness, consciousness, ambition. The same personality aspects were positively correlated with blurred vision, impaired stereovision, blurred distance and near vision.”

These findings may not yet be sufficient to construct a preoperative test for predicting success and satisfaction with multifocal IOLs. However, some useful indications are emerging, Dr. Goes said. – by Michela Cimberle

• Frank Goes, MD, can be reached at Willem Klooslaan 6, B – 2050 Antwerp, Belgium; +32-3-2193925; fax: +32-3-2196667; email: frank@goes.be.
• Disclosure: Dr. Goes is a consultant for Carl Zeiss Meditec.

Magda Rau

This study confirmed that demanding, ambitious patients are not eligible candidates for multifocal IOLs or, at least, are candidates who need special attention. The questionnaire proposed in this study is a useful tool to help select the right multifocal IOL among those available on the market. It is, of course, no substitute for chair time, but can be used as a starting point for discussion. Research on patient selection questionnaires should be continued in the future. Tests should not be too long or too difficult. They should be understandable by all patients, including those with lower educational levels. On the surgeon’s side, they should facilitate consultation with the patient without resulting in additional bothersome paperwork.

— Magda Rau, MD
Augenklinik Cham, Germany