Exposing the LASIK Scam

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 Post subject: Disparity between "satisfaction" and complications
PostPosted: Fri Apr 18, 2008 11:13 pm 

Joined: Sat Nov 26, 2005 1:23 pm
Posts: 2080
J Cataract Refract Surg. 2004 Sep;30(9):1861-6.
Reasons patients recommend laser in situ keratomileusis.
Bailey MD, Mitchell GL, Dhaliwal DK, Wachler BS, Olson MD, Shovlin JP, Pascucci SE, Zadnik K.
Ohio State University College of Optometry, Columbus, OH 43210, USA.

PURPOSE: To evaluate the reasons patients who have had laser in situ keratomileusis (LASIK) recommend it to others and examine the disparity between high levels of satisfaction and patient reports of night-vision symptoms and/or dry eye after LASIK.

SETTING: Northeastern Eye Institute, Scranton, and the University of Pittsburgh, Pittsburgh, Pennsylvania, and the University of California at Los Angeles, Los Angeles, California, USA.

METHODS: Questionnaires assessing symptoms and satisfaction after LASIK were mailed to 2,100 patients. The questionnaires included items about nightvision symptoms and satisfaction and an open-ended question for patients to give their reasons for recommending LASIK to others. The open-ended responses were categorized and tabulated.

RESULTS: Four hundred thirty-four patients provided reasons for recommending LASIK to others. Sixteen categories of reasons were identified. "No more spectacles/contact lenses" was listed by 180 patients (42%), followed by "better vision" (21%) and "convenience" (15%). Women were significantly more likely to cite "better comfort" (27 women versus 3 men; chi square = 8.99, P =.003) and "better quality of life" (41 women versus 9 men; chi square = 7.36, P =.007) as a reason for recommending LASIK. Of the 35 patients who reported dissatisfaction with post-LASIK vision, 20 (57%) would recommend LASIK to a friend because "LASIK helps others."

CONCLUSIONS: Categories of reasons for recommending LASIK to others were similar to reasons given by patients for seeking LASIK. Some patients who reported dissatisfaction with their vision said they would recommend LASIK, suggesting that recommendation of LASIK to others is not necessarily a measurement of the quality of a patient's vision after LASIK.

From the full text:

Previous investigations have characterized patient satisfaction and complaints, such as night-vision symptoms and dry eye, after laser in situ keratomileusis (LASIK).1, 2, 3, 4, 5, 6 Although night-vision symptoms have been reported in 12% to 57% of patients3, 4, 5, 6, 7, 8, 9 and dry-eye symptoms have been reported in 4% to 9%,2, 10 post-LASIK satisfaction remains very high. For example, Hill6 reported that 15 (7.5%) of 200 patients considered their night-vision symptoms to be ?considerably worse? than before LASIK. Yet, 195 of them (97.5%) reported they were ?extremely happy? and only 1 reported being ?slightly unhappy.? Similar disparities have been reported after photorefractive keratectomy (PRK). Brunette et al.11 found that 31.7% of PRK patients reported a decrease in night vision; nevertheless, 91.8% were satisfied or very satisfied with their surgery. In a previous study,9 we characterized the factors associated with nightvision symptoms and decreased satisfaction following LASIK. We also found a disparity between the relatively frequent report of postoperative night-vision symptoms and high patient satisfaction. Ninety-seven percent of patients in our sample of LASIK patients would recommend LASIK to a friend.9 When asked to rate satisfaction with their vision, patients reported a median score of 100% of the maximum value on the visual analogue scale (mean 87.2%). Yet, 30.0% reported halos, 27.2% reported glare, and 24.5% reported starbursts when asked about these symptoms in a questionnaire. While this disparity can be explained by assuming that the symptoms were not severe enough to adversely affect satisfaction reports, there may be other explanations.

The purpose of this study was to further investigate explanations for this disparity by examining and categorizing the reasons post-LASIK patients say they would recommend LASIK to a friend. We also looked for associations between categories of reasons for recommending LASIK and factors known to be associated with an increase in postoperative night-vision symptoms and decreased satisfaction after LASIK. There is more than 1 plausible explanation for the disparity between the relatively common frequency of postoperative complaints and the high levels of satisfaction after LASIK. The first is that the night-vision symptoms and symptoms of dryness after LASIK are mild relative to the benefits of LASIK, so patient satisfaction remains high. There are, however, other explanations.

The discrepancy between symptoms and satisfaction has also been reported after PRK. Brunette et al.11 conclude, ?[Patients'] self-conditioning to the belief in the success of this expensive and irreversible surgery was not assessed in the present study. However, if such a psychological process prevailed, one would expect patients to deny the secondary effects such as glare and night vision problems. This was not the case here. Patients may simply adapt to their new condition.? The idea that patients may adapt to their new condition is a second explanation for the disparity between symptoms and satisfaction. The third explanation for this disparity is one that is dismissed by Brunette et al. Although a specific ?psychological process? is not mentioned in their report, they may be referring to a process called cognitive dissonance. The theory of cognitive dissonance suggests that individuals need to have consistency among their attitudes or beliefs.15 The theory can apply to many types of decisions, ie, purchases and surgical procedures, and the effects of cognitive dissonance have been investigated in nonocular surgical procedures.16, 17 Certain criteria are required for dissonance to be induced following a decision.18 First, the decision must be important and the consumer/patient must have invested substantial money or psychological cost. Second, the consumer/patient must freely choose to make the purchase or have the surgical procedure. Finally, the commitment must be irreversible. It is evident that the LASIK procedure meets all 3 criteria for inducing cognitive dissonance in patients who have post-LASIK complications/side effects. Homer and coauthors17 predict that cognitive dissonance might have less effect on specific questions about symptoms and a greater effect on questions about the overall success of the surgical procedure, such as whether the patient would have the procedure again or recommend the procedure to others. This prediction is supported by our previous study in LASIK patients and by Brunette et al.9, 11 Cognitive dissonance should be explored in future studies as an explanation for the disparity between the relatively frequent occurrence of postoperative symptoms and the high levels of satisfaction.

Broken Eyes

"The price good men pay for indifference to public affairs is to be ruled by evil men." Plato

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