Visual function and subjective perception of visual ability after macular hole surgery

Am J Ophthalmol. 2004 Dec;138(6):995-1002. doi: 10.1016/j.ajo.2004.07.049.


Purpose: To evaluate the functional and anatomical results of macular hole surgery and to explore its effect on patients' Health-Related Quality Of Life (HR-QOL) and to investigate the associations between self-reported HR-QOL and conventional measures of visual function.

Design: Case series.

Methods: The National Eye Institute 25-Item Visual Function Questionnaire (VFQ-25) and the 36-Item Short-Form Health Survey (SF-36) were self-administered by 30 patients before and 4 months after macular hole surgery. Preoperative, intraoperative, and postoperative clinical data were collected including visual acuity, contrast sensitivity, and metamorphopsia. Multi-item scales rating different aspects of HR-QOL were compared before and after surgery, and their correlation with traditional methods of outcome evaluation was analyzed.

Results: Macular hole closure was achieved in 26 patients (87%). Mean LogMAR visual acuity improved by 6 +/- 10 letters for distance and 7 +/- 12 letters for near. Metamorphopsia was reduced by a mean of 35 +/- 70 squares on Amsler chart, and Pelli-Robson contrast sensitivity decreased by a mean of -0.09 +/- 0.3 log units postoperatively. The VFQ-25 composite score as well as scale scores associated with general vision, near vision, vision-related mental health, and role difficulties were significantly improved (P < .05) after successful closure of macular hole. Conversely out of the eight SF-36 health concepts, limitation in usual role activities because of emotional problems was the only one that significantly improved postoperatively. Both baseline and postoperative best-corrected visual acuity significantly correlated with most of the VFQ subscale scores before and after surgery, respectively.

Conclusions: In this case-series, macular hole surgery appears to have a beneficial effect on patients' subjective perception of visual function. The use of vision-targeted health status questionnaires in conjunction with detailed clinical examination provides a more comprehensive overview of individuals' daily well-being after surgical intervention. Further controlled studies are required to confirm our findings.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Contrast Sensitivity / physiology
  • Female
  • Health Status*
  • Humans
  • Intraoperative Complications
  • Male
  • Middle Aged
  • Ophthalmologic Surgical Procedures
  • Postoperative Complications
  • Prospective Studies
  • Quality of Life*
  • Retinal Perforations / physiopathology
  • Retinal Perforations / surgery*
  • Sickness Impact Profile
  • Surveys and Questionnaires
  • Visual Acuity / physiology*