LASIK patients have better emotional well-being compared with controls

Patients seeking LASIK do not appear to have an increased risk of suicidal behavior prior to the procedure, but their medication history reveals a relatively high use of antidepressants, according to one expert.

"In April 2008, patient advocates reported to the FDA that poor surgical outcomes after LASIK surgery can be devastating and may even lead to suicidal behavior in extreme cases," said Dr. Twa, assistant professor, College of Optometry, University of Houston.

"The purpose of our study was to understand the baseline characteristics of emotional well-being of people seeking LASIK surgery," he continued. "Using an extensive self-administered questionnaire to investigate multiple psychological dimensions, we found that our study indicates emotional well-being is better among patients seeking LASIK when compared with a control group comprised of individuals seeking eye care for reasons other than refractive surgery.

"Further study is also needed to understand the differences between surgical results and patient reported outcomes," Dr. Twa said. "Ultimately, it would be helpful to know the psychological impact of surgical outcomes with LASIK and to determine if there are psychological or behavioral characteristics that are predictive of unsuccessful patient-reported outcomes. Some of these issues are the topics of the ongoing LASIK Quality of Life study, a collaborative project involving the FDA, National Institutes of Health-National Eye Institute, and the Department of Defense announced in October."

Analyzing HEaL results

The data reported by Dr. Twa were collected in the Health, Emotional Well-Being and LASIK (HEaL) study, an unfunded collaborative project involving several members of the Optometric Council on Refractive Technology. Initiated in February 2008, the study entered patients by sequential enrollment at five clinical centers and asked them to complete a questionnaire at presentation.

The LASIK-seeking cohort was comprised of patients who were interested in LASIK, fulfilled eligibility criteria for the procedure, and had no previous refractive surgery; to be included in the study analysis, they had to have undergone the refractive procedure after completing the questionnaire. The control group consisted of patients who presented for care for a reason other than refractive surgery but who would be eligible for the procedure based on their ocular characteristics.

The self-administered survey included 128 items and was derived from several different standardized instruments for determining emotional well-being.

"The survey that we used was a compilation of standard instruments developed and validated by suicide researchers to assess factors associated with suicide behavior," noted Dr. Twa. "Life-event stress, depression, drug and alcohol use, impulsivity, and self-esteem are established risk factors in suicide research. In addition, we asked patients specifically about suicidal ideation, which was important, but an uncommon and potentially difficult topic to raise in the course of a routine eye exam."

The study included 119 patients in the seeking LASIK group and a comparison group of 94 patients. Demographic analysis showed no significant differences between the two groups in mean age (~38 years), gender distribution (~70% female), or race/ethnicity (~85% white). Socioeconomic data showed that the study population was overall highly educated, employed, and affluent. The only significant differences noted were that LASIK patients had a higher median income and were significantly more likely than their counterparts to be married.