Patient outcomes of refractive surgery - The Refractive Status and Vision Profile

Purpose: To evaluate the performance of a questionnaire, the Refractive Sta tus and Vision Profile (RSVP), in the assessment of patient outcomes follow ing refractive surgery. Setting: Patients recruited from 5 refractive surgery practices. Methods: The RSVP was self-administered by patients before and 2 to 6 month s after bilateral refractive surgery. Information on uncorrected visual acu ity (UCVA), refractive error, and self-reported satisfaction with vision wa s also collected. Changes in total RSVP scores and in the scores of RSVP su bscales (concern, functioning, driving, symptoms, optical problems, glare, and trouble with corrective lenses) were assessed. The relationship between change in the RSVP and subscale scores was assessed in relation to change in traditional clinical measures. The responsiveness of the RSVP to clinica lly meaningful changes in patients' vision was measured by calculating its effect size. Results: One hundred seventy-six patients completed baseline and postoperat ive RSVPs and had bilateral refractive surgery. Postoperatively, 92.0% of p atients had a UCVA of 20/40 or better in at least 1 eye. fifteen percent ha d some worsening in the total RSVP score, and there was substantial variati on in the proportion of patients who had worsening in particular subscale s cores, ranging from 7.0% who reported worsening in trouble with corrective lenses to 41.5% who reported worsening in driving. Change in satisfaction w ith vision following surgery was correlated with change in the overall RSVP and subscale scores but not with change in refractive error. A significant worsening in 3 or more RSVP subscales was independently associated with an almost 6-fold (odds ratio 5.84, 95% confidence interval: 1.88,18.13) likel ihood of patient report of dissatisfaction with vision, after adjusting for age, sex, preoperative refractive error, and post-operative UCVA. Low scor es (ie, minimal dysfunction) on 2 of the RSVP subscales (physical functioni ng and optical problems) at baseline were predictive of poor postoperative patient outcomes. The RSVP was very sensitive to the intervention of refrac tive surgery (effect size of 1.2 to 1.4). Conclusions: The RSVP was able to detect clinically relevant changes in fun ctional status and quality of life after refractive surgery. Change ill the RSVP score was correlated with change in patient report of satisfaction an d was predictive of postoperative patient satisfaction. The RSVP provides a valuable new metric to assess outcomes of refractive surgery.