title: Assessment of visual function after corneal transplantation: the quality of life and psychometric assessment after corneal transplantation (Q-PACT) study.
abstract: OBJECTIVE
  Many patients with successful corneal grafts have poor vision postoperatively. This study evaluates changes in vision-related quality of life after penetrating keratoplasty (PK).
  
  
  METHODS
  Multicenter prospective cohort study.
  
  
  METHODS
  Penetrating keratoplasty candidates from the university-affiliated ophthalmology clinics of four participating centers were enrolled and followed up prospectively. We used the PK-VFQ, a modified version of the Visual Function Index-14, combined with clinical examinations before and at 6 and 12 months after PK. We used multivariate linear regression models to examine predictors of change in PK-VFQ scores.
  
  
  RESULTS
  We studied 74 grafts in 71 eyes of 67 patients aged 23 to 91 (mean, 61) years who were followed up for at least 6 months. Indications for surgery included bullous keratopathy (27%), scarring (16%), keratoconus (16%), dystrophies (16%), and regrafts (15%). Median preoperative visual acuity was 20/200 in the graft candidate and 20/30 in the best eye. Median best-corrected postoperative visual acuity in the operated eyes was 20/60 at 6 months. PK-VFQ scores improved at 6 months in 79% by an average of 13.0 points (range, -16.7 to 67.5). Improvement in PK-VFQ scores was associated with younger age (P =.04), poorer preoperative visual acuity in the best eye (P =.001), and postoperative contact lens use (P =.04) but not with postoperative acuity in the grafted eye (P =.49). Postoperatively, 80% of patients were moderately to very satisfied with their vision, and 97% of patients stated they would have the surgery again.
  
  
  CONCLUSIONS
  Improvement in visual function is inversely associated with visual acuity in the better-seeing eye but does not correlate with the postoperative acuity in the grafted eye. Although most keratoplasties are done unilaterally in the setting of good visual acuity in the contralateral eye, for the majority of patients visual function improves after PK.
authors.affiliation: Massachusetts Eye and Ear Infirmary and Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Flavia
authors.initials: F
authors.lastname: Mendes
authors.forename: Debra A
authors.initials: DA
authors.lastname: Schaumberg
authors.forename: Sam
authors.initials: S
authors.lastname: Navon
authors.forename: Roger
authors.initials: R
authors.lastname: Steinert
authors.forename: Joel
authors.initials: J
authors.lastname: Sugar
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Holland
authors.forename: M Reza
authors.initials: MR
authors.lastname: Dana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003315:Cornea / Q000502:physiology*; D003316:Corneal Diseases / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014792:Visual Acuity / Q000502:physiology*