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Improvement in Functional Visual Acuity and Patients’ Satisfaction after LASIK Enhancement. Keiko Sakatani, MD 1) , Ikuko Toda, MD 1) Chikako Sakai 1) , Yukako Kamiyama 1) Yoshiko Hori-Komai, MD 1) , Kazuo Tsubota, MD 1) 2) 1) Minamiaoyama Eye Clinic, Tokyo, Japan

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improvement in functional visual acuity and patients satisfaction after lasik enhancement

Improvement in Functional Visual Acuity and Patients’ Satisfaction after LASIK Enhancement

Keiko Sakatani, MD1), Ikuko Toda, MD1)

Chikako Sakai1), Yukako Kamiyama1)

Yoshiko Hori-Komai, MD1), Kazuo Tsubota, MD1) 2)

1) Minamiaoyama Eye Clinic, Tokyo, Japan

2) Department of ophthalmology, Keio University

School of Medicine, Tokyo, Japan

The authors have no financial interests

purpose
Purpose

Patients who undergo LASIK sometimes complain of blurred vision and desire LASIK enhancement even when their uncorrected visual acuity (UCVA) is 20/20 or better.

To investigate the reasons which may be associated with the patients’ satisfaction for the outcomes of refractive surgery using a comparison of dissatisfied patients with satisfied patients who had the same levels of UCVA and spherical equivalence (SE).

To determine the efficacy of LASIK enhancement for patients with complaints of their visual performance after initial LASIK.

patients and methods
Patients and Methods

We retrospectively analyzed 9 eyes of 5 patients who were dissatisfied after LASIK at Minamiaoyama Eye Clinic due to blurred vision, although their UCVA was 20/20 or better and they underwent LASIK enhancement (dissatisfied group) .

We also analyzed 11 eyes of 8 patients who were satisfied with the outcomes and had corresponding levels of UCVA and SE with the dissatisfied group (satisfied group).

The functional visual acuity (FVA) was measured continuously for 60 seconds in a blink-allowed period using the FVA measurement system (Nidek, Aichi, Japan).

functional visual acuity 1
Functional Visual Acuity (1)

The FVA measurement system is made up of three parts: hard disc, monitor and joystick. The Landolt rings are presented on the monitor, and their sizes change depending on the correctness of the responses.

The optotype is displayed starting with smaller one which the patient can recognize correctly (equal to UCVA). If the response is incorrect, a larger optotype is presented automatically. When there is no response within the set display times, the answer is taken to be an error and the optotype automatically enlarges.

functional visual acuity 2
Functional Visual Acuity (2)

Correct answer

The results of FVA is displayed as follows:

FVA is calculated as a line which equalizes the area of gray and black after a 60-second test. The timing and number of blinks are observed and recorded by an examiner.

While conventional visual acuity measures a maximum visual ability, FVA stands for a daily visual performance.

Decimal VA/ LogMAR

↓Blink

Starting VA

FVA

comparison of dissatisfied with satisfied patients
Comparison of Dissatisfied with Satisfied Patients

BUT=tear-film breakup time SRI=surface regularity index

SAI=surface asymmetry index HOA=higher order aberration

*Satisfaction level was marked as 0 (very satisfy) to 4 (very dissatisfy) by patients.

There are statistically significance in FVA and satisfaction between the 2 groups.

the change in ucva
The Change in UCVA

20/10

20/16

Mean 20/13

20/20

Mean 20/18

20/40

P=0.0007

20/100

Before enhancement

3 months after

the change in se
The Change in SE

Diopter

+1.0

+0.5

Mean +0.17D

0

-0.5

Mean -0.30D

P=0.302

-1.0

Before enhancement

3 months after

the change in fva
The Change in FVA

20/10

P=0.001

20/16

20/20

Mean 20/17

20/40

Mean 20/28

20/100

20/200

3 months after

Before enhancement

the change in satisfaction
The Change in Satisfaction

Satisfied

0

1

2

Mean 0.33

3

P=0.001

4

Mean 2.33

Dissatisfied

Before enhancement

3 months after

the change in but sai sri hoa
The Change in BUT / SAI / SRI / HOA

There were no significant differences.

conclusions
Conclusions

Measurement of FVA seems to more sensitively assess visual performance than conventional visual acuity testing.

UCVA, FVA and patients’ satisfaction were improved after LASIK enhancement for patients who were dissatisfied with the outcomes of initial surgery.

FVA measurement could be useful in determining patients’ satisfaction and an indication of retreatment after refractive surgery.