Happy Patient Project
clinical and psychometric results
2011
ESCRS 2011
Impact of personality characteristics on satisfaction after
multifocal IOL-implantation – the “Happy Patient Study”
Ulrich Mester, MD, Frank Goes MD, Werner Huetz MD, Thomas Neuhann MD, Stefanie Schmickler MD, Peter
Szurman MD, Thomas Vaterrodt, MD
Corresponding author: Ulrich Mester, MD, Augenzentrum im Medizeum, Europaallee 15, 66113 Saarbruecken, Germany, email:
prof.mester@email.de
Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.
Introduction:
•
At the present the implantation of bi- or multifocal intraocular lenses (MIOL) is the best established method to gain spectacle
independence after cataract surgery.
•
Many investigations reveal a percentage of more than 80% of patients being satisfied after MIO-implantation without need for any glasses
(1,2,3,5,6,7).
•
Patient’s satisfaction depends on a myriad of factors as optic design of the MIOL, near addition, light transmittance, characteristics, pupil
diameter, and the visual needs of each individual patient for far, intermediate, and near distances.
•
Clinical studies with MIOL`s of different optic designs (refractive, diffractive, hybrid) showed comparable results with small percentage of
unsatisfied patients. (Authors).
•
Dissatisfaction in these patients is often not correlated to the objective visual outcome.
•
Why do some patients report not to profit from multifocal lenses and/or to suffer seriously from side effects as halos and glare without
objective findings which could explain these subjective intolerance?
•
The postoperative exploration of these patients let to the consideration that there may be individual personality characteristics which make
the difference between objective findings and subjective feelings.
•
We therefore performed a prospective multicentre study to investigate possible personality factors which would enable us to select the
good candidates to become “Happy Patients”.
Patients and methods:
Study Group and Protocol
•
In a prospective study, patients with bilateral MIOL-implantation were enrolled in 8 European ophthalmological centres. According to
statistical needs a minimal number of 150 patients had to be included without restriction for recruitment in each centre. Inclusion criteria
were bilateral implantation of MIOL in eyes without pathological findings except cataract, not more than 1.5 D astigmatism, informed
consent of the study protocol, and patients being able and willing to answer the study questions preoperatively and at two control visits,
three and six months after surgery of the second eye. Another major inclusion criterion was patient’s motivation for spectacle
independence.
•
Ophthalmological data and questionnaires where send to and evaluated by an independent reading centre (T.V.).
Intraocular Lenses
•
Each centre was free to choose the MIOL´s of it`s own preference. The following lenses where implanted: Tecnis ZM900 (29%), Tecnis
ZMA00 (26%) (AMO), ReSTOR+4 (21%), ReSTOR+3 (10%) (Alcon), AcriLisa (4%) (Zeiss).
ESCRS 2011
Table 2: Distribution of the different MIOL models on
right and left eyes
OS
OD Tecnis
ZM900
ReZoom
Tecnis
ZMA00
Tecnis
ZM900
23
18
10
ReZoom
13
1
2
Tecnis
ZMA00
12
ReSTOR+4
2
ReSTOR+4
AcriLisa
ReSTOR+3
2
35
37
AcriLisa
8
ReSTOR+3
20
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Table 3: Visual performance of activities in different
distances 3 months after surgery.
n=163
easy
Near (e.g.reading)
Intermediate
(e.g.computer work)
Far (e.g.TV)
85%
62%
85%
difficult
9%
26%
12%
Not able without glasses
6%
12%
3%
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• The general satisfaction after MIOL implantation was high: 82.2%
would decide again for this procedure, only 3.7% would not, 14.1%
were uncertain at the 3-months control. These results were nearly
unchanged after 6-months (82.5%, 2.8%, and 14.8%).
• A more detailed presentation of the degree of satisfaction is shown
in figure 3. Obviously, the percentage of patients being satisfied or
completely satisfied increases from 3 to 6-months after surgery
wereas the group of only moderately satisfied patients decreases.
The small unsatisfied group of patients remains constant. There was
no significantly difference between females and males.
• Out of 23 patients being unsatisfied or only moderately satisfied 11
patients were completely spectacle independent. One patient was
unsatisfied and 10 patients were moderately unsatisfied with their
visual performance. One patient reported on severe, five of strong,
and five of moderate glare. The impact of halos was described as
severe by two, as strong by three, and as moderate by six patients.
Reduced vision under mesopic conditions was severe in one
patient, strong in one patient and moderate in four patients.
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Table 4: Pronounced personality characteristics
evaluated by the psychometric tests
N=183
%
No personality disorder
9
self-discipline
5
orderliness
29
deliberation
29
achievement striving
38
competence
44
dutifulness
.
51
compulsive checking
60
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Table 5: Correlation of postoperative satisfaction with
data other than psychometric (no difference at the two observation periods).
Correlation with postoperative satisfaction
Significance
Gender
n.s
Preoperative expectations and accepted limitations
n.s
Less postoperative cylinder
<0.05
Spectacle independence distance
<0.01
Spectacle independence near
<0.05
God vision in different distances and different lighting conditions
< 0.01
Less bothering by side effects as photic phenomena
Glare
Halos
< 0.01
Less blurred vision
Near
Distance
< 0.01
Less problems under mesopic conditions
< 0.01
More activities without spectacles
< 0.05
< 0.01
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< 0.01
Table 6: Correlation of psychometric characteristics with
postoperative side effects, visual function, and satisfaction.
Correlation with psychometric data
Significance
Compulsive checking
Glare
Halos
Stereo vision
Distance vision
< 0.05
< 0.01
< 0.01
< 0.05
Orderliness
Glare
Halos
Stereo vision
Mesopic vision
< 0.01
< 0.05
< 0.05
< 0.05
Competence
Glare
Halos
Postoperative satisfaction
< 0.05
< 0.05
< 0.01
Dutifulness
Halos
Stereo vision
< 0.05
< 0.05
achievement striving
deliberation
self-discipline
n.s
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Conclusion:
• Individual personality disorders does significantly influence the
tolerance of side effects and patients satisfaction after MIOL
implantation. Therefore a preoperative evaluation of psychometric
data may help to get more ´Happy patients`.
• The results of these study can be used to concentrate such a
manual on the most relevant questions.
ESCRS 2011
The “New Happy Patient” questionaire
female
male
Age
Strongly
disagree
I’m known for my prudence and common sense
I would rather keep my options than plan everything in advance
I try to perform all the tasks assigned to me conscientiously
I don’t take civic duties like voting seriously
I keep my belongings neat and clean
Sometimes I’m not dependable or reliable as I should be
I keep myself up-to-date and usually make clever decisions
I am not a very methodical person
I pay my debts promptly and in full
I often come into situations without being fully prepared
I like to keep everything in its place so I know just where it is
Sometimes I cheat when I am playing card games on my own
I pride myself on my sound judgement
I never seem to be able to get organized
When I make a commitment, I can always be counted on to follow
through
Before I know what I want I need to think it through
I check things several times to be on the safe side
I repeat activities frequently until I am happy with it
Some thoughts don’t get out of my mind
I always need to check once more if I have closed the door properly
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Disagree
Neutral
Agree
Strongly
agree
The “New Happy Patient” questionaire
Strongly disagree
I’m known for my prudence and common sense
I would rather keep my options than plan everything in advance
I try to perform all the tasks assigned to me conscientiously
I don’t take civic duties like voting seriously
I keep my belongings neat and clean
Sometimes I’m not dependable or reliable as I should be
I keep myself up-to-date and usually make clever decisions
I am not a very methodical person
I pay my debts promptly and in full
I often come into situations without being fully prepared
I like to keep everything in its place so I know just where it is
Sometimes I cheat when I am playing card games on my own
I pride myself on my sound judgement
I never seem to be able to get organized
When I make a commitment, I can always be counted on to follow through
Before I know what I want I need to think it through
I check things several times to be on the safe side
I repeat activities frequently until I am happy with it
Some thoughts don’t get out of my mind
I always need to check once more if I have closed the door properly
ESCRS 2011
Disagree
Neutral
Agree
Strongly agree
Thank you for your attention
ESCRS 2011