Quality of life and depression in patients with high and low myopia before and after laser-assisted subepithelial keratectomy (LASEK)

Quality of life is a complex concept to be evaluated.Quality of life refers to a personchr('39')s expectations, goals, concerns, and level of her/his satisfaction with life. In recent decades, especially after the 1990s, quality of life has been considered as an important factor in assessing the health, well-being, social functioning and rehabilitation programs. In ophthalmology, indicators such as visual acuity are used to evaluate the outcome of treatment. This indicator shows the success of the treatment but it can’t reflect the emotion and perception of patients from their myopia. Myopia can affect people’s quality of life and can cause problems in driving, reading and using computers, and as a result, these problems can affect the psychological status of people. People use many methods to correct this problem. The use of spectacles and contact lenses has often been the first choice of people to correct their myopia but today, surgery is considered a better option. LASEK is a new method for eye surgery and this method has more advantages than LASIK surgery and PRK. LASEK also has fewer risks than other surgeries. There are several questionnaire and scales for measuring the quality of life in ocular patients. But none of them has addressed the psychological statues, personality traits and the importance of cosmesis in these patients. IER QOL deals with all these factors. The purpose of this study is evaluate of quality of life and depression in patients with high and low myopia that undergone to laser-assisted sub epithelial keratectomy (LASEK).

This study is descriptive. 311 patients are participated before LASEK surgery. 185 patients have high myopia and 126 patients have low myopia. This was done in javad ol’aeme eye specialist clinic in Qom. Patients in this study ranged in age from 21 to 40 years. Their refractive errors of patients should not be less than 5. Preoperative patients were informed of the secondary evaluation after surgery. For evaluating of quality of life, IER QOL was used. The IER QOL scale was specifically developed to evaluate QOL in patients with myopia and can be administered rapidly and easily in clinics. This multidimensional scale assesses physical status, psychological state, personality traits, and cosmesis, which are dimensions associated with a patientchr('39')s QOL. The IER QOL scale has the following subscales validated through factor analysis and confirmatory factor analysis: Frequency of disturbing visual and ocular symptoms that assess the patients visual symptoms that patients experience, Tolerance to disturbing visual and ocular symptoms, Health Proneness Psychological Traits Questionnaire that assess the patients how to adjust to different environments and their mental well-being, self-efficacy and compatibility, Personality traits (extraversion/introversion) and Cosmesis assess the patientchr('39')s belief in the effect of vision correction method on their beauty and attractiveness. In addition, the scale assesses patient satisfaction with the current treatment for correcting myopia. Physical status subscale has 26 questions, psychological status subscale has 10 questions, and personality traits have 3 questions. Internal validity of this Questionnaire with Cronbachchr('39')s alpha coefficient in cosmesis subscale was 0/77, 0/80 in psychological condition, 0/73 in extroversion and introversion, and 0/88 in frequency of disturbing visual, ocular symptoms and tolerance to disturbing visual and ocular symptoms. The second questionnaire used in this study was Beck Depression Inventory. This questionnaire has 21 questions that range from 0 which shows the no symptoms and 3 which shows high symptoms. In this study patients answer the IER QOL and Beck Depression Inventory before undergone to surgery. 13 patients didn’t participate in second evaluation.

Result showed that quality of life after LASEK surgery was significantly better than before (p<0.001). Quality of life in low myopia patients was significantly better than other group. Patients with high myopia had a significant improvement in cosmesis (p<0.001). Patients with low myopia (p<0.052) and high myopia (p<0.063) didn’t have any significant change in depression. But there was a significant difference in depression between high and low myopia groups before and after surgery.

The purpose of this study was to evaluate the quality of life and depression in patients who have been candidates for LASEK surgery. According to the results, LASEK surgery has a significant effect on the quality of life of ocular patients. As previous research has shown, LASEK surgery has fewer negative and more positive effects than LASIK surgery. The results of this study are similar with them. In general, the quality of life of patients with high myopia is lower than people with low myopia. According to the results obtained in this study, it can be said that the degree of myopia can have a significant impact on quality of life. In the extroversion / introversion subscale, the increase in extraversion characteristics in these patients showed that myopia can affect their avoidance of extraversion or their self-confidence. They also found greater ability to adapt better to new environments. Cosmesis is another reason that can be important in choosing surgery to correct myopia in patients. As shown in this study, patientschr('39') perceptions of their cosmesis changed significantly after surgery. Perception of cosmesis in patients with high myopia is lower than the other group, so it can be said that people with high myopia have to use thicker spectacles and it affects their perception of their cosmesis. In the group with high myopia, psychological status was lower than the other group. But both groups showed significant improvement in this factor after surgery. According to these results, it can be said that psychological status is a valuable variable to be evaluated in these patients and is also an important factor that affects the quality of life. Because the secondary evaluation in this study was two months after surgery, it is better to evaluate these patients after a longer period of time to assess their quality of life after the complete disappearance of symptoms after surgery. Depression in both groups is normal. However, the group with high myopia had a higher mean before and after surgery than the group with low myopia. However, according to the results, both groups did not show a significant change in their depression. It can be stated that depression is not an important factor to motivate these patients to have surgery.