Sensitivity of the National Eye Institute Refractive Error Quality of Life instrument to refractive surgery outcomes

PURPOSE: To evaluate scores from the National Eye Institute Refractive Error Quality of Life instrument (NEI-RQL) relative to refractive surgery outcomes in myopic patients. SETTING: Large institutional ophthalmic practices. METHODS: Patients seeking refractive surgery (n = 59) self-administered the NEI-RQL before and 6 months after surgery; the comparison group of myopes and emmetropes (n = 72) not seeking refractive surgery also completed the NEI-RQL. Myopic patients seeking refractive surgery had bilateral, same-day laser in situ keratomileusis (LASIK) treatment. Regression analyses were conducted to compare survey scores in the LASIK treatment group before surgery with those in the myopic sample who were not seeking refractive surgery and to compare the survey scores in the post-LASIK treatment group (surgical emmetropes) to those in the naturally emmetropic group. Logistic regression was used to determine NEI-RQL subscales that were related to myopic patients seeking refractive surgery and myopic patients not seeking refractive surgery. RESULTS: Myopes seeking LASIK reported greater expectations for vision improvement (P<.0001), greater activity limitations (P<.0001), suboptimal correction (P =.04), worse appearance (P<.0001), and lower satisfaction (P<.0001) than myopes not seeking refractive surgery. Logistic regression showed that worse self-perceived appearance (odds ratio 20.71), more dissatisfaction with current correction (odds ratio 8.28), and higher expectations for "optimal" correction (odds ratio 6.41) were independently associated with myopes seeking LASIK, while better perceived "clarity of vision" (odds ratio = 0.20) was associated with myopes not seeking surgery. Overall, surgical emmetropes were similar to natural emmetropes in terms of refractive-error-specific quality of life (clarity of vision, near vision, far vision, diurnal fluctuations) and clinical measures of visual function, yet they reported significantly better appearance (P =.02) and greater satisfaction (P<.0001) than natural emmetropes. CONCLUSION: The NEI-RQL demonstrated vision-related quality-of-life differences when comparing patient samples associated with refractive surgery.