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Vision-Related Impact on Quality of Life in an Elderly Patient Population After Corneal Transplantation

Puri, Sidharth BA; Robinson, Shaun B. MD; Wang, Jiangxia MA, MS; Sikder, Shameema MD

doi: 10.1097/ICO.0000000000000021
Clinical Science

Purpose: The aim of this study was to assess the vision-related quality of life (QOL) and satisfaction of elderly patients who underwent corneal transplantations.

Methods: Survey data using a modified version of the Visual Function Index were collected in February–March 2013 from 175 patients (age ≥65 years) of 414 eligible patients who underwent corneal transplantation between 2008 and 2010 at the Wilmer Eye Institute. The survey assessed visual functionality, independence, and satisfaction. Transplant surgeries were limited to penetrating keratoplasty, Descemet stripping automated endothelial keratoplasty (DSAEK), and keratoprosthesis. Sociodemographic and clinical data, including age, sex, initial and follow-up visual acuities, were collected. QOL survey measures were compared with patients' clinical findings to assess the differences between objective and subjective visual functioning.

Results: One hundred seventy-two patients were reviewed for surgery type. Eighty-six of 172 (50%) patients had follow-up data. Controlling for age, procedure, and baseline logarithm of the minimum angle of resolution (logMAR) visual acuity, patients treated by penetrating keratoplasty (P = 0.002) or keratoprosthesis (P = 0.019) were found to have poorer QOL scores than those treated with DSAEK. Age was positively associated with QOL improvement (P = 0.005). A relatively lower baseline vision (higher logMAR) was associated with a worse QOL (P < 0.001). When asked directly about their QOL, patients with relatively higher baseline vision (lower logMAR) reported no change in their QOL (P = 0.046).

Conclusions: Type of surgery (DSAEK), older recipient age, and better baseline vision seem to be associated with an improved QOL in this study. Vision at follow-up is not associated with a QOL decline. Based on these findings, it is suggested that transplant surgery should be considered for elderly patients.

*Johns Hopkins School of Medicine, Baltimore, MD;

Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD; and

Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.

Reprints: Shameema Sikder, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 7315 Wisconsin Avenue, West Tower, Suite 610, Bethesda, MD 20814 (e-mail:

Supported by the Stephen J. Ryan Faculty Scholar fund.

The contributions of the authors are as follows: design (S.P., S.R., S.S.) and conduct (S.P., S.R., J.W., S.S.) of the study; collection (S.P., S.R.), management (S.P., S.R.), analysis (S.P., S.R., J.W., S.S.), and interpretation (S.P., S.R., S.S.) of the data; and preparation (S.P., S.R., S.S.), review (S.P., S.R., S.S.), or approval (S.P., S.R., J.W., S.S.) of the article.

The authors have no funding or conflicts of interest to disclose.

Received August 16, 2013

Accepted September 30, 2013

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.