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Invited Commentary
June 18, 2020

Vision-Related Function Following Retinal Detachment Repair—Looking Beyond the Letter Chart

Author Affiliations
  • 1Department of Ophthalmology, Baylor College of Medicine–Cullen Eye Institute, Houston, Texas
JAMA Ophthalmol. Published online June 18, 2020. doi:10.1001/jamaophthalmol.2020.2023

Just about every vitreoretinal surgeon can think of a patient who underwent a successful retinal detachment repair—perhaps even resulting in 20/20 visual acuity—but reported suboptimal visual function. Surgeons often use the word successful to describe patient outcomes that meet or exceed certain objective criteria; for rhegmatogenous retinal detachment (RRD) repair, the focus is often primarily on anatomic reattachment and secondarily on best-corrected visual acuity levels. While these are important measures, they represent surgeon-set metrics rather than patient-reported parameters. We place so much emphasis on how many letters in a bright white box a patient can identify while sitting in an artificially darkened room yet fail to account for 99% of their vision-dependent daily activities, such as driving, reading, and socializing. There is growing interest in patient-centered functional outcomes for a variety of retinal conditions, including macular degeneration, epiretinal membrane, and diabetic macular edema, because it is clear that visual acuity is far more complex than just the number of letters one can read on a chart.

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    1 Comment for this article
    EXPAND ALL
    Measuring Patient Quality of Life Following Retinal Detachment Repair
    Ruth Albright, B.S. Chemical Engineering | Patient Macular Off Rhegmatogenous Detachment April 2018
    First of all, I'd like to commend you for studying this topic. I experienced a macula-off detachment in my right eye in April 2018. I was extremely fortunate to have surgery the same day because I already had a relationship with a retina practice. The surgeon who performed the repair is a very talented and caring individual, as is my regular retina doctor and I have had a "successful" outcome as measured by the eye chart and anatomical attachment. Let me also say that I have deep appreciation for the medical providers who repaired my eye.

    Secondly, as a
    patient, it is very unsatisfying to have your surgery described as "successful" and have both horizontal and vertical distortions in your field of vision that exceed 100 percent of the underlying image. By this I mean, looking at a line of print on a television and having a "hump" on the left side that is more than 100 percent displaced from the actual line position. Or, observing the left hand side of the television to be 50 to 60 percent taller than the right hand side. As an aside, the cognitive dissonance that you experience looking at a large rectangular object and seeing it as a large trapezoid is disconcerting to say the least.

    I had an epiretinal membrane "grow" post-surgically at the 6 to 8 month time frame so I had an epiretinal membrane peel performed at Bascom-Palmer in February 2019. That surgery eliminated much of the distortion in both the horizontal and vertical planes. My primary retina doctor made the referral to B-P and the surgeon at B-P is also a very talented and caring individual. In my case, because of my eye length (~30 mm), it made sense to go to a larger medical center for the epiretinal peel.

    I am happy with the outcome of the two surgeries. I have vision in my right eye that I wouldn't otherwise have. I have difficulties, though, each and every day with activities of daily living because the images in my eyes are not the same. I find that I have to read much slower than before and that I am constantly "surprised" by "things" on my right side because I don't have the visual field of vision or sense that I previously had. I have developed compensations for this disability. I race in triathlons and I have to be cognizant of both biking and running surfaces because I can no longer see them as well as previously. I don't whitewater kayak anymore because I really cannot see the details of rapids well enough to boat safely. These are not catastrophic problems by any means, although they are annoying to me.

    In summary, I think an assessment of patient satisfaction with visual outcomes from surgery is important. I think that any assessment has to tease out the difference between what I'll call "primary" drivers of satisfaction and "secondary" drivers of satisfaction. For me, my primary drivers are fully satisfied. I can do most anything I want without excess limitation. My secondary drivers are less satisfied but I don't know how to weigh those drivers.

    I do want to reiterate my sincere appreciation of the doctors at Retina Specialists of Carolina, specifically Drs. Renfro and Hall, and Dr. Fortun at Bascom-Palmer in West Palm Beach, Fl. These gentlemen and their staff continue to take care of my sight and I appreciate their skills and talents.

    Sincerely,
    Ruth Albright
    CONFLICT OF INTEREST: None Reported
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