Skip to main content
NCBI home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 2000 Jan;84(1):60–66. doi: 10.1136/bjo.84.1.60

Visual function after penetrating keratoplasty for keratoconus: a prospective longitudinal evaluation

A Brahma 1, F Ennis 1, R Harper 1, A Ridgway 1, A Tullo 1
PMCID: PMC1723235  PMID: 10611101

Abstract

AIMS—To evaluate visual function and vision specific health status in patients undergoing penetrating keratoplasty for keratoconus.
METHODS—A prospective longitudinal study measuring logMAR visual acuity, contrast sensitivity, disability glare, binocular visual field, stereoacuity, and subjective visual function (VF-14) was conducted on 18 patients with keratoconus undergoing penetrating keratoplasty (PK), including six patients who had already had PK in the fellow eye. Data were collected preoperatively and at 3, 9, and 18 months after surgery.
RESULTS—Within 3 months of surgery there was significant improvement in aided visual acuity, contrast sensitivity, and stereoacuity (p<0.05); disability glare (p<0.05) no longer had a significant detrimental effect on these variables. VF-14 score improved significantly throughout the postoperative period (p<0.05). There was significant correlation of the VF-14 score with aided visual acuity, binocular visual field, and stereoacuity. Postoperative astigmatism (<4D v >4D) did not affect the VF-14 score significantly.
CONCLUSIONS—There is substantial and rapid improvement in visual function and vision specific health status in keratoconic patients as a result of uncomplicated penetrating keratoplasty.



Full Text

The Full Text of this article is available as a PDF (125.3 KB).

Figure 1  .

Figure 1  

Open in a new tab

The median corrected logMAR visual acuity scores for the operated and fellow eyes.

Figure 2  .

Figure 2  

Open in a new tab

Median corrected contrast sensitivity scores for the operated and fellow eyes.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adamsons I. A., Vitale S., Stark W. J., Rubin G. S. The association of postoperative subjective visual function with acuity, glare, and contrast sensitivity in patients with early cataract. Arch Ophthalmol. 1996 May;114(5):529–536. doi: 10.1001/archopht.1996.01100130521004. [DOI] [PubMed] [Google Scholar]
  2. Applegate W. B., Miller S. T., Elam J. T., Freeman J. M., Wood T. O., Gettlefinger T. C. Impact of cataract surgery with lens implantation on vision and physical function in elderly patients. JAMA. 1987 Feb 27;257(8):1064–1066. [PubMed] [Google Scholar]
  3. Armitage W. J., Moss S. J., Easty D. L., Bradley B. A. Supply of corneal tissue in the United Kingdom. Br J Ophthalmol. 1990 Nov;74(11):685–687. doi: 10.1136/bjo.74.11.685. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bailey I. L., Bullimore M. A., Raasch T. W., Taylor H. R. Clinical grading and the effects of scaling. Invest Ophthalmol Vis Sci. 1991 Feb;32(2):422–432. [PubMed] [Google Scholar]
  5. Bernth-Petersen P. Visual functioning in cataract patients. Methods of measuring and results. Acta Ophthalmol (Copenh) 1981 Apr;59(2):198–205. doi: 10.1111/j.1755-3768.1981.tb02979.x. [DOI] [PubMed] [Google Scholar]
  6. Bodis-Wollner I. Detection of visual defects using the contrast sensitivity function. Int Ophthalmol Clin. 1980 Spring;20(1):135–153. doi: 10.1097/00004397-198002010-00007. [DOI] [PubMed] [Google Scholar]
  7. Carney L. G., Lembach R. G. Management of keratoconus: comparative visual assessments. CLAO J. 1991 Jan;17(1):52–58. [PubMed] [Google Scholar]
  8. Carney L. G. Visual loss in keratoconus. Arch Ophthalmol. 1982 Aug;100(8):1282–1285. doi: 10.1001/archopht.1982.01030040260012. [DOI] [PubMed] [Google Scholar]
  9. Doyle S. J., Harper C., Marcyniuk B., Ridgway A. E. Prediction of refractive outcome in penetrating keratoplasty for keratoconus. Cornea. 1996 Sep;15(5):441–445. [PubMed] [Google Scholar]
  10. Elliott D. B., Bullimore M. A. Assessing the reliability, discriminative ability, and validity of disability glare tests. Invest Ophthalmol Vis Sci. 1993 Jan;34(1):108–119. [PubMed] [Google Scholar]
  11. Elliott D. B., Hurst M. A., Weatherill J. Comparing clinical tests of visual function in cataract with the patient's perceived visual disability. Eye (Lond) 1990;4(Pt 5):712–717. doi: 10.1038/eye.1990.100. [DOI] [PubMed] [Google Scholar]
  12. Esterman B. Functional scoring of the binocular field. Ophthalmology. 1982 Nov;89(11):1226–1234. doi: 10.1016/s0161-6420(82)34647-3. [DOI] [PubMed] [Google Scholar]
  13. Hess R. F., Carney L. G. Vision through an abnormal cornea: a pilot study of the relationship between visual loss from corneal distortion, corneal edema, keratoconus, and some allied corneal pathology. Invest Ophthalmol Vis Sci. 1979 May;18(5):476–483. [PubMed] [Google Scholar]
  14. Holladay J. T., Prager T. C., Trujillo J., Ruiz R. S. Brightness acuity test and outdoor visual acuity in cataract patients. J Cataract Refract Surg. 1987 Jan;13(1):67–69. doi: 10.1016/s0886-3350(87)80016-0. [DOI] [PubMed] [Google Scholar]
  15. Kirkness C. M., Ficker L. A., Steele A. D., Rice N. S. The success of penetrating keratoplasty for keratoconus. Eye (Lond) 1990;4(Pt 5):673–688. doi: 10.1038/eye.1990.95. [DOI] [PubMed] [Google Scholar]
  16. Koenig S. B., McDermott M. L., Hyndiuk R. A. Penetrating keratoplasty and intraocular lens exchange for pseudophakic bullous keratopathy associated with a closed-loop anterior chamber intraocular lens. Am J Ophthalmol. 1989 Jul 15;108(1):43–48. doi: 10.1016/s0002-9394(14)73258-1. [DOI] [PubMed] [Google Scholar]
  17. Lee P. P., Spritzer K., Hays R. D. The impact of blurred vision on functioning and well-being. Ophthalmology. 1997 Mar;104(3):390–396. doi: 10.1016/s0161-6420(97)30303-0. [DOI] [PubMed] [Google Scholar]
  18. Mannis M. J., Zadnik K., Johnson C. A., Adams C. Contrast sensitivity after penetrating keratoplasty. Arch Ophthalmol. 1987 Sep;105(9):1220–1223. doi: 10.1001/archopht.1987.01060090078032. [DOI] [PubMed] [Google Scholar]
  19. Mannis M. J., Zadnik K., Johnson C. A. The effect of penetrating keratoplasty on contrast sensitivity in keratoconus. Arch Ophthalmol. 1984 Oct;102(10):1513–1516. doi: 10.1001/archopht.1984.01040031233025. [DOI] [PubMed] [Google Scholar]
  20. Marmor M. F., Gawande A. Effect of visual blur on contrast sensitivity. Clinical implications. Ophthalmology. 1988 Jan;95(1):139–143. doi: 10.1016/s0161-6420(88)33218-5. [DOI] [PubMed] [Google Scholar]
  21. Marron J. A., Bailey I. L. Visual factors and orientation-mobility performance. Am J Optom Physiol Opt. 1982 May;59(5):413–426. doi: 10.1097/00006324-198205000-00009. [DOI] [PubMed] [Google Scholar]
  22. Moseley M. J., Hill A. R. Contrast sensitivity testing in clinical practice. Br J Ophthalmol. 1994 Oct;78(10):795–797. doi: 10.1136/bjo.78.10.795. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Musch D. C., Farjo A. A., Meyer R. F., Waldo M. N., Janz N. K. Assessment of health-related quality of life after corneal transplantation. Am J Ophthalmol. 1997 Jul;124(1):1–8. doi: 10.1016/s0002-9394(14)71636-8. [DOI] [PubMed] [Google Scholar]
  24. Pardhan S., Gilchrist J. Binocular contrast sensitivity with monocular glare disability. Ophthalmic Physiol Opt. 1990 Jan;10(1):37–39. [PubMed] [Google Scholar]
  25. Pardhan S., Gilchrist J. The effect of monocular defocus on binocular contrast sensitivity. Ophthalmic Physiol Opt. 1990 Jan;10(1):33–36. [PubMed] [Google Scholar]
  26. Price F. W., Jr, Whitson W. E., Marks R. G. Progression of visual acuity after penetrating keratoplasty. Ophthalmology. 1991 Aug;98(8):1177–1185. doi: 10.1016/s0161-6420(91)32136-5. [DOI] [PubMed] [Google Scholar]
  27. Rubin G. S., Adamsons I. A., Stark W. J. Comparison of acuity, contrast sensitivity, and disability glare before and after cataract surgery. Arch Ophthalmol. 1993 Jan;111(1):56–61. doi: 10.1001/archopht.1993.01090010060027. [DOI] [PubMed] [Google Scholar]
  28. Steinberg E. P., Tielsch J. M., Schein O. D., Javitt J. C., Sharkey P., Cassard S. D., Legro M. W., Diener-West M., Bass E. B., Damiano A. M. The VF-14. An index of functional impairment in patients with cataract. Arch Ophthalmol. 1994 May;112(5):630–638. doi: 10.1001/archopht.1994.01090170074026. [DOI] [PubMed] [Google Scholar]
  29. Vail A., Gore S. M., Bradley B. A., Easty D. L., Rogers C. A. Corneal graft survival and visual outcome. A multicenter Study. Corneal Transplant Follow-up Study Collaborators. Ophthalmology. 1994 Jan;101(1):120–127. doi: 10.1016/s0161-6420(94)31376-5. [DOI] [PubMed] [Google Scholar]
  30. Walraven J. Amblyopia screening with random-dot stereograms. Am J Ophthalmol. 1975 Nov;80(5):893–900. doi: 10.1016/0002-9394(75)90286-x. [DOI] [PubMed] [Google Scholar]
  31. Ware J. E., Jr, Sherbourne C. D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed] [Google Scholar]
  32. Williams K. A., Ash J. K., Pararajasegaram P., Harris S., Coster D. J. Long-term outcome after corneal transplantation. Visual result and patient perception of success. Ophthalmology. 1991 May;98(5):651–657. doi: 10.1016/s0161-6420(91)32238-3. [DOI] [PubMed] [Google Scholar]
  33. Wood J. M., Wild J. M., Smerdon D. L., Crews S. J. Alterations in the shape of the automated perimetric profile arising from cataract. Graefes Arch Clin Exp Ophthalmol. 1989;227(2):157–161. doi: 10.1007/BF02169790. [DOI] [PubMed] [Google Scholar]
  34. Zadnik K., Barr J. T., Edrington T. B., Everett D. F., Jameson M., McMahon T. T., Shin J. A., Sterling J. L., Wagner H., Gordon M. O. Baseline findings in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. Invest Ophthalmol Vis Sci. 1998 Dec;39(13):2537–2546. [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES