Vision-Related Quality-of-Life Assessment Using NEI VFQ-25 in Patients After Boston Keratoprosthesis Implantation

Abstract

The quality of life of patients who underwent KPro significantly improved postoperatively compared with their preoperative status. These results did not change when stratifying by visual acuity of the contralateral eye.

Impact of type I Boston keratoprosthesis implantation on vision-related quality of life

“…These findings suggest that KPro implantation improves visual acuity and the patient’s participation in daily tasks, and vision-specific emotional well-being—despite the relatively intensive follow-up management required especially early postsurgery. Our study was consistent with a previous report of a mean significant improvement in the overall score of the NEI-VFQ-25 in a similar clinical sample of patients undergoing KPro surgery 6. However, our study was able to analyse the impact of KPro on subscales such as reading and accessing information, mobility and independence; and emotional well-being scores.…”

“…As most patients in our study suffered from end-stage corneal disease with poor vision in both eyes, our study suggests that the benefit of KPro implantation extends beyond improvement in visual acuity. This observation is similar to the only other study on VRQoL in patients with KPro,6 where despite a relatively low BCVA, patients report a great improvement in VRQoL, suggesting that the perceived benefit may be larger than what is estimated by outcome measures such as vision. In support of this observation, we also found that the changes in BCVA postoperatively were not significantly associated with changes in VRQoL scores, that is, BCVA only explained a low percentage of the variance in VRQoL outcomes in our multivariate analysis.…”

“…Thus, in our study population the impact of KPro implantation on VRQoL is not completely driven just by changes (improvements or decreases) in visual acuity. This was highlighted by previous studies that have reported the benefits of KPro extending beyond visual acuity, such as improvements in the various components of the visual system including colour, contrast and peripheral vision 6. Conversely, this is also important as we frequently observe that visual acuity may worsen after KPro implantation with the onset of complications such as retroprosthetic membrane formation and glaucoma 1…”

“…A recent literature review on KPro outcomes suggests that most patients benefited from improved visual acuity, with 54%–84% achieving 20/200 vision in the short term,1 although none of these studies assessed the impact of KPro on the patients’ QoL. To our knowledge, only one published study has attempted to quantify vision-related quality of life (VRQoL) after KPro implantation and they found an improvement in overall VRQoL using the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) 6. However, the NEI-VFQ-25 has been found to have several psychometric shortcomings, including multidimensionality, when analysed using modern psychometric approaches such as Rasch analysis 7.…”

Boston type 1 keratoprosthesis from patient selection through postoperative management: a review for the keratoprosthetic surgeon

“… 10 , 11 A recent study evaluated patient responses to the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) following Kpro implantation, and found a significant improvement in quality-of-life measures even in those patients with vision better than 20/200 in their nonsurgical eye. 12 To optimize outcomes, patients should possess certain essential characteristics, including adequate lid anatomy, good blink function, controlled ocular surface inflammation, and a sufficiently moist ocular surface.…”