Patient-reported tool helps assess symptoms, vision perception after IOL implantation

Use of the 37-item Assessment of IntraOcular Lens Implant Symptoms (AIOLIS) instrument appears effective in evaluating symptoms and general perceptions of vision associated with cataract surgery and intraocular lens (IOL) implants, reports a study.

The authors developed a standardized patient-reported outcome measure of visual perceptions and symptoms for implanted premium and monofocal IOLs, which was administered by web survey with mail follow-up and phone reminders.

Adults scheduled for binocular implantation of the same IOL type completed the survey at baseline prior to surgery (n=716) and postoperatively (n=554). Of the respondents, 64 percent were female, 81 percent White, 89 percent aged ≥61 years, and 62 percent had some college or more education.

Outcomes measured were frequency, severity, and level of bother in the last 7 days for 14 symptoms, namely glare, hazy vision, blurry vision, starburst, halos, snowballs, floaters, double images, rings and spider webs, distortion, light flashes with eyes closed, light flashes with eyes open, shimmering images, and dark shadows.

At baseline, the median correlation among these symptoms was 0.19. The mean uncorrected binocular visual acuity improved from a preoperative value of 0.47 logarithm of the minimum angle of resolution (logMAR; Snellen 20/59) to a postoperative value of 0.12 (20/26), while the best-corrected binocular visual acuity improved from 0.23 logMAR (20/34) preoperatively to 0.05 logMAR (20/22) postoperatively.

The most bothersome symptoms decreased after the procedure: preoperative/postoperative glare (84 percent/36 percent), blurry vision (68 percent/22 percent), starbursts (66 percent/ 28 percent), hazy vision (63 percent/18 percent), snowballs (55 percent/17 percent), and halos (52 percent/22 percent).

All symptoms were significantly reduced (p<0.0001) after surgery, except for dark crescent-shaped shadows (4 percent/4 percent).

Symptoms deemed quite a bit or extremely bothersome such as blurry vision (54 percent/15 percent), snowballs (52 percent/14 percent), glare (49 percent/15 percent), and halos (46 percent/14 percent) decreased after surgery, except for dark shadows (29 percent/32 percent).

“Having monofocal IOL implants was associated with significantly more reduction in halos, starbursts, glare, and rings and spider webs, but less improvement in self-reported general vision,” the authors said.