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59 59 Reviewing LASIK outcomes by Steven C. Schallhorn, MD Studies report important data regarding patient satisfaction after LASIK R esearch analyzing patient-reported outcomes is providing valuable data about patients' quality of life and quality of vision after LASIK. PROWL The PROWL (Patient-Reported Out- comes With LASIK) 1 (6 months, 262 military subjects) and PROWL 2 (3 months, 312 non-military sub- jects) studies examined patients' re- sponses to LASIK (without enhance- ments). 1,2 Participants responded to an online questionnaire referencing photos demonstrating examples of symptoms such as halos and starbursts. As presented at the 2014 Amer- ican Academy of Ophthalmology annual meeting by the principle in- vestigators, the prevalence of ocular symptoms (ghosting, glare, halos, and starbursts) after LASIK decreased in every category. When partici- pants were asked about bothersome symptoms, the prevalence decreased in every category. Some patients who did not have symptoms preop- eratively had them postoperatively, but on average symptoms decreased. When patients were asked about their ability to perform usual activities based on their visual symptoms, difficulty decreased in each category after LASIK. However, up to 1% experienced substantial difficulty or could not perform usual activities because of visual symptoms when they were asked at 3 months. Based on the Ocular Surface Disease Index questionnaire ad- ministered during PROWL 1, fewer patients had symptoms 6 months after surgery compared with before surgery. Five years post-LASIK In a 5-year European study evaluat- ing more than 3,300 patients yearly after LASIK, approximately 94% wore no glasses for distance vision 5 years after LASIK (analysis by Dr. Schallhorn and Biostatistics Department, Optical Express, not yet published). In this study, when patients who had LASIK 5 years previously were asked if they noticed glare within the past 4 weeks, almost 81% reported that they did not notice glare at all (Figure 1). Approximate- ly 17% noticed some glare without glasses or contact lenses, and 2% reported glare even with glasses or contact lenses. Of the 477 patients who no- ticed glare, 78% reported that they only see it sometimes. When they were asked how bothersome the glare is, approxi- mately 19% responded that it was not bothersome at all and approx- imately 64% said it was a little bothersome. Less than 1% of the total population had great difficulty with usual activities. Patients can have visual symp- toms, but they are rare 5 years after surgery. LASIK versus soft contact lenses We matched a sample of patients who underwent LASIK 1 year prior and habitual soft contact lens wear- ers for age and refraction (myopia, preop for LASIK) (analysis by Dr. Schallhorn and Biostatistics De- partment, Optical Express, not yet Figure 1. Patients were asked if they noticed any glare within the previous 4 weeks. In the past 4 weeks, have you noticed any glare? 100% 75% 50% 25% 0% 17.2% 2.0% 80.8% Yes, without glasses or contact lenses Yes, even with glasses or contactlenses No, not at all Supported by a grant from Abbott Medical Optics published). The binocular distance vision was better in those who had LASIK versus the habitual vision of those wearing soft contacts. One reason for the difference is that soft contact lens wearers with lower amounts of astigmatism (1.0 D and below) generally do not wear toric contact lenses. This small amount of astigmatism can slightly impair unaided vision, especially at the 20/16 level, whereas lower amounts of astigmatism are routinely correct- ed with LASIK. Contact lens wearers also had more discomfort compared with LASIK patients. Conclusion The PROWL study demonstrated a significant decrease in quality of vision symptoms. However, up to 1% could have significant difficulty without correction after surgery. Five-year outcomes of LASIK showed that 94% do not use distance visual correction. Similar to the PROWL study, less than 1% have significant difficulty with their quality of vision after surgery with- out correction. Finally, we found that in a sample of LASIK and contact lens wearers matched for age and refrac- tion, LASIK resulted in better unaid- ed distance vision and less ocular discomfort compared with patients who wear soft contact lenses. References 1. www.fda.gov/downloads/MedicalDevices/ ProductsandMedicalProcedures/Surgeryan- dLifeSupport/LASIK/UCM419443.pdf 2. www.fda.gov/downloads/MedicalDevices/ ProductsandMedicalProcedures/Surgeryan- dLifeSupport/LASIK/UCM421192.pdf Dr. Schallhorn is professor of oph- thalmology, University of California, San Francisco; chief medical director, Optical Express, Glasgow, U.K.; and in private practice in San Diego. He can be contacted at scschallhorn@yahoo. com.

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