In a study that may change how surgeons evaluate candidates for LASIK and other elective surgery in the future, researchers Jennifer Morse, MD, Steven C. Schallhorn, MD, and David J. Tanzer, MD are finding that a patient's personality may influence their overall satisfaction and visual quality of life after refractive surgery.

Dr. Morse and her colleagues used extensive surveys before and after LASIK surgery to gather data about 309 consecutive patients who underwent LASIK surgery at the Naval Medical Center, San Diego (NMCSD). Dr. Morse is retired chairman of psychiatry at NMCSD and is subspecialty board-certified in psychosomatic medicine.


Study goal: Improving patient satisfaction

"With this research, our goal is to develop customized clinical assessment tools that will guide surgeons and their staff to be more effective in their...screening, communication and counseling of refractive surgery patients," said Dr. Morse in an article published in Ophthalmology Times.

According to Dr. Morse, initial results of their study suggest that surgeons should "include an objective evaluation of personality factors" in their screening of patients prior to refractive surgery.


20/20 doesn't always mean a happy patient

Achieving 100% patient satisfaction after LASIK and other refractive surgery procedures can be challenging. In some cases, patients may achieve uncorrected visual acuity of 20/20 after surgery, but may feel their vision isn't as "sharp" as it was prior to surgery when they wore eyeglasses or contact lenses.

And some patients may have a more difficult time coping with a less-than-perfect outcome than others, expressing great dissatisfaction or experiencing emotional distress as a result.


Study results

In the NMCSD study, all 309 patients completed a standardized 240-item personality survey prior to surgery and a 40-item vision and quality-of-life survey before and 1 month after their LASIK procedure.

At 1 month after surgery:

• 88% of the patients had visual quality of life scores that indicated they were highly satisfied with the results of their LASIK procedure.
• Only 2% of the patients had scores indicating that they were highly dissatisfied with the outcomes of their surgery.

The researchers evaluated a number of variables to see which factors had the greatest influence on visual quality of life scores after LASIK. Variables considered included: age, gender, pupil diameter, refractive error prior to surgery, contrast sensitivity, uncorrected visual acuity (UCVA) after surgery, personality index, and age.

Only three factors were significant. In descending order of importance, they were:

• UCVA after surgery
• personality index
• age

Dr. Morse noted that the finding that UCVA (after surgery) played the largest role was expected, and that age having an effect may be related to the need for reading glasses among LASIK patients who are over age 40 due to presbyopia.

The finding that a patient's personality may play a significant role in their satisfaction after LASIK surgery supports Dr. Morse's suggestion that evaluating a LASIK candidate's personality prior to surgery should be considered. Depending on their personality profile, some LASIK candidates may need more intensive pre-operative counseling when deciding whether to proceed with refractive surgery.

Also, Dr. Morse suggests surgeons attempt to take each patient's personality factor into account when communicating with them to promote greater understanding and help manage their expectations regarding treatment options and results.


Further analysis and potential benefits

The researchers are continuing to analyze the data of the NMCSD study to determine the role pre-existing psychological conditions, such as depression, may have on the quality of life patients are likely to experience after LASIK surgery.

Dr. Morse sees benefits of the study extending beyond patient selection and management for LASIK surgery. In addition to her work with ophthalmologists, she looks forward to continuing to educating physicians and surgeons of other specialties about how to communicate more effectively with patients of different personality styles.

Dr. Morse also points out that it's important for doctors to know that different patients have different coping styles, and these styles affect how they deal with perceived surgical outcomes. "All of these issues can relate to patient selection and treatment management," she adds.


SOURCE: "Personality influences visual quality of life post-LASIK." Ophthalmology Times. March 15, 2008.

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