title: Vision-related impact on quality of life in an elderly patient population after corneal transplantation.
abstract: OBJECTIVE
  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.
authors.affiliation: *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.
authors.forename: Sidharth
authors.initials: S
authors.lastname: Puri
authors.forename: Shaun B
authors.initials: SB
authors.lastname: Robinson
authors.forename: Jiangxia
authors.initials: J
authors.lastname: Wang
authors.forename: Shameema
authors.initials: S
authors.lastname: Sikder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D057111:Descemet Stripping Endothelial Keratoplasty; D005260:Female; D016330:Frail Elderly; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D017060:Patient Satisfaction; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D014785:Vision, Ocular / Q000502:physiology*; D014792:Visual Acuity / Q000502:physiology