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Patient reported outcome measures (PROMs) in corneal cross-linking: an innovative tool correlated to objective measures

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Session Details

Session Title: Cross-Linking

Session Date/Time: Sunday 06/09/2015 | 08:00-09:30

Paper Time: 08:00

Venue: Main Auditorium

First Author: : S.Hamada UK

Co Author(s): :    H. Hamami   S. Malde                 

Abstract Details


Corneal Cross linking (CXL) is a relatively new technique for the management of keratoconus and corneal ectasia following corneal refractive surgery. Currently, there are no tools to measure subjective outcomes of CXL and its impact on quality of life. Patient Reported Outcome Measures (PROMs) are quality of life (QoL) instruments to measure patients satisfaction, effectiveness of treatment, and health gain as seen by patients following CXL. We describe a new tool to measure subjectively the outcomes of CXL, and to correlate those to commonly used objective measures in assessing outcomes of CXL.


Corneo plastic unit, Queen Victoria Hospital, East Grinstead in association with Brighton and Sussex Medical School.


A questionnaire was designed to assess certain psychometric parameters and vision-related quality of life following CXL for progressive keratoconus. The questionnaire was distributed to fifty consecutive patients attending follow-up appointments minimum six months after CXL in an outpatient settings. Visual acuities and objective measures of Kmax, Kmean, corneal pachymetry at the thinnest point and difference in pachymetry between corneal apex and thinnest point were measured with scheimpflug based corneal topography. QoL measures were compared against objective findings to check for correlation.


50 questionnaires were analysed according to 6 domains:Peace of mind,activities of daily living,social relationships,ocular pain,knowledge and understanding.All patients showed improvement in quality of life scores and all 6 domains.95% of patients felt the surgery was worthwhile.Those with visual acuity worse than 6/36 scored better on activities of daily living and social relationships while those with vision 6/24-6/9 felt more confident to drive and lives normal life.A steep keratometric reading >52 diopters (D) was associated with lower scores on the Mental Health, Driving, Dependency, and Ocular Pain scales.There was a positive correlation between Keratometric measurement (Kmax, Kmean, and thinnest point of the cornea) and scores across all domains.The correlation was strongest when examining fear of blindness and social relationship (p<0.05)


A new QoL instrument that is specific for ecstatic eye diseases appears to be of important value and correlates positively with commonly accepted objective measures in assessing outcomes of corneal cross linking.

Financial Interest:


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