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• W2414643574 abstract "We thank Somner et al for their important contribution regarding patient-reported outcomes and long-term sustainability with respect to keratoplasty outcomes in response to a recent article.1Coster D.J. Lowe M.T. Keane M.C. Williams K.A. A comparison of lamellar and penetrating keratoplasty outcomes: a registry study.Ophthalmology. 2014; 121: 979-987Abstract Full Text Full Text PDF PubMed Scopus (168) Google Scholar The authors are correct about their described and ideal approach for developing a patient questionnaire. Developing a patient questionnaire from inception is a lengthy process that can be shortened by beginning with and modifying an existing instrument. Catquest-9SF is a vision-related activity limitation instrument that was developed and validated for cataract surgery by Lundström et al.2Lundström M. Behndig A. Kugelberg M. et al.The outcome of cataract surgery measured with the Catquest-9SF.Acta Ophthalmol. 2011; 89: 718-723Crossref PubMed Scopus (37) Google Scholar Lundström is in the process of validating this instrument for corneal transplantation, and this is reasonable given that the same optical factors influence vision in the setting of cataract and corneal disease.3Seery L.S. McLaren J.W. Kittleson K.M. Patel S.V. Retinal point-spread function after corneal transplantation for Fuchs' dystrophy.Invest Ophthalmol Vis Sci. 2011; 52: 1003-1008Crossref PubMed Scopus (26) Google Scholar, 4Seery L.S. Nau C.B. McLaren J.W. et al.Graft thickness, graft folds, and aberrations after Descemet stripping endothelial keratoplasty for Fuchs dystrophy.Am J Ophthalmol. 2011; 152: 910-916Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar With preliminary analyses, Lundström states, “We tested Catquest-9SF for corneal transplantation and a Rasch analysis showed that the questionnaire worked with ordered response categories, good fit statistics, one dimensional, good measurement precision and reasonably good targeting” (personal communication, June 6, 2014). The authors are correct that other problems affecting corneal transplant patients may not be captured with this instrument, and development of a multidimensional instrument is needed, where factors in addition to visual disability, such as pain relief, are to be taken into account. Regarding the authors' second issue, minimizing donor tissue wastage and maximizing donor use is clearly desirable for any type of transplant. The authors make an important point that new lamellar corneal transplantation techniques offer the possibility of treating 2 corneas by 1 donor. That this will result in a 50% increase in the donor supply might be optimistic, however, given that implementation of this practice can be complicated, that the practice may be prevented by regulations, and that lamellar procedures could have higher acceptance worldwide (e.g., deep anterior lamellar keratoplasty in the United States) and with lower intraoperative conversion rates from lamellar to penetrating keratoplasty. However, the point of the article by Coster et al was that the “real-world” survival of lamellar grafts is currently worse than for penetrating grafts,1Coster D.J. Lowe M.T. Keane M.C. Williams K.A. A comparison of lamellar and penetrating keratoplasty outcomes: a registry study.Ophthalmology. 2014; 121: 979-987Abstract Full Text Full Text PDF PubMed Scopus (168) Google Scholar which is at odds with the assumptions of surgeons. By measuring, understanding, and solving apparent discrepancies in outcomes, patient care should improve, and use of donor corneas should be maximized. Finally, a single dataset with agreed definitions and outcomes for an international registry would represent an enormous advance for comparing and improving outcomes internationally. Although not all countries have a corneal transplant registry, benchmarking between registries that do exist would enable broad international comparisons, if a consensus can be reached on the definition and measurement of the outcomes. Re: Coster et al.: A comparison of lamellar and penetrating keratoplasty outcomes: a registry study (Ophthalmology 2014;121:979–87)OphthalmologyVol. 122Issue 1PreviewThe article by Coster et al1 with its linked editorial2 raises interesting issues about the specification and measurement of outcomes in corneal graft surgery. The articles highlight a number of issues which bear further discussion. Patient-reported outcome measures are discussed as instruments that may clarify which surgical technique is best and we agree that “the ultimate measure by which to judge the quality of a medical effort is whether it helps patients as they see it.”3 However, the suggestion that the Catquest-9SF may be of use in better assessing the outcomes of graft surgery may not stand up to rigorous scrutiny. Full-Text PDF" @default.
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