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First Author: Z.Shalchi UK
Co Author(s): J. Dermott S. Perera
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To identify patient and surgical factors leading to dissatisfaction after laser-assisted in situ keratomileusis (LASIK)
Ultralase, a large multi-surgeon, multi-clinic nationwide refractive surgery group in the UK
We conducted a retrospective review of LASIK procedures performed between January 2011 and March 2012. Patients underwent LASIK with femtosecond laser flap creation and were seen 1 week, 1 month and 6 months thereafter. Post-operatively, patient satisfaction was assessed using a 5-point scale: S5 (couldnt be better), S4 (pleased with results), S3 (satisfactory outcome), S2 (had hoped for better), and S1 (regret having it done). We used a surgical database to gather information on patient age, gender, pre- and post-operative mean spherical equivalent (MSE) refraction, uncorrected distance visual acuity (UCVA), corrected distance visual acuity (CDVA), treatment failure and complications. As well as this, we collected patient satisfaction data, and defined dissatisfaction as patients with satisfaction grades S1 and S2.
Eighteen thousand, nine hundred and fifty five LASIK procedures were included (mean age, 38.5 years; male, 43.6%). 98.5% were satisfied with their post-operative result (S5, 63.6%; S4, 30.0%; S3, 4.9%). 1.5% of patients were dissatisfied (S2, 1.4%; S1, 0.1%). Dissatisfied patients were significantly older than satisfied patients (mean, 46.2 v 38.4 years, p<0.001), and were more likely to have had correction for hyperopia (34.0% v 14.0%, p<0.001). Post-operatively, dissatisfied patients had lower UDVA (mean acuity letters, 86.7 v 99.6, p<0.001), lower CDVA (mean, 99.1 v 102.4, p<0.001) and greater residual refractive error (MSE from target, 0.74D v 0.25D, p<0.001). Dissatisfied patients were also more likely to have developed peri- or post-operative complications (mean risk, 9.68% v 1.13%, p<0.001). Gender was not associated with dissatisfaction (satisfied males, 43.7%; dissatisfied males, 40.8%, p=0.33), nor was the magnitude of pre-operative MSE refraction (satisfied, 3.41D; dissatisfied, 3.42D; p=0.89).
Increased age and hyperopic pre-operative refractive error are associated with increased post-LASIK dissatisfaction. Dissatisfaction is also associated with higher post-operative refractive error and surgical complications. Gender and magnitude of pre-operative refraction are not associated with dissatisfaction.