Wait time and Vision and Health Problems in Adults Expecting Corneal Transplantation at a Hospital in Montreal, Canada M Alizadeh-Ebadi MD, H Boisjoly MD MPH, F Djafari MD MSc, E Freeman PhD, J Lachaine PhD, I Brunette MD Boston, MA April 7-9, 2010 The authors have no financial interest in the subject matter of this poster. 1

Purpose Wait time for corneal transplantation still is a problem in Montreal, Canada. Anticipated results: Subjects waiting for PK or DSAEK corneal grafts have worse visual acuity, lower VF-14 scores, more pain or discomfort, more restriction in physical and social activities; they are more depressed, fall more, and use health care services more frequently than subjects with normal vision not scheduled for eye surgery. 2

Cross-sectional, Case-Control designed with age/gender group-matching, single institution study. Cases are patients on corneal transplant waiting list as of January 31, 2009 at Maisonneuve-Rosemont Hospital in Montreal, Canada. Three groups of consecutive consenting adults aged 50 years and older were enrolled (n total=75): PK Candidates (n=25) DSAEK Candidates (n=25) Controls with good vision and no planned surgery (n=25) Average age of patients was 73 and 2/3 were females. 94% of participants were Caucasian. Materials 3

Materials Outcome measures (1) Visual health measures: Daily life visual function VF-14 questionnaire. [10,18,19] Ocular symptom score including pain and discomfort: modified CSS (Cataract Symptom Scale) questionnaire. [20] BCVA for distance was measured with ETDRS chart. [21] 4

Materials Outcome measures (2) General health measures: Geriatric Depression Scale–(GDS-15). [22-25] Medical Outcomes Study, 36-item Short-Format Health Survey (SF-36) questionnaire. [26-28] Medical comorbidities (14 questions about frequent health problems). [29] Number of falls and burns during the past year. [31] 5

Materials Outcome measures (3) Wait time measures: Duration in days from completion of the surgery admission form to the time of the study; review of medical record. Acceptability of wait time; question. Patient expectation measures: Patient expected wait time at the time of study; question. Estimation of perceived utility of the surgery: EQ-5D (also referred as EuroQol) questionnaire to estimate utility. [33-35] 6

Wait time results Mean accumulated wait time was 20.0±15.6 months. Perceived wait time was 26.7±22.9 months. 58% found this unacceptable. Transplant candidates felt their wait time should be around 7.9±5.2 months. 7

Table 1: Pre operative Corneal Graft Diagnoses DiagnosisDSAEK (n=25)PK (n=25) Fuchs’ Endothelial dystrophy 80% (20)8% (2) Bullous Keratopathies20% (5)48% (12) Failed Penetrating Keratopathy 0% (0)20% (5) HSV and interstitial Keratitis 0% (0)12% (3) Traumatic Keratitis0% (0)4% (1) Keratoconus0% (0)4% (1) Fungal Keratitis0% (0)4% (1) 8

On the Snellen chart: 0.1 logMAR corresponds to 6/7.5, 0.2 to 6/9.5, 0.4 to 6/15, 0.6 to 6/24, 1.2 to 6/95, and 1.3 to 6/120 Table 2: Visual Acuities Visual Acuity Mean LogMAR ± SD GroupP value CORNEAL GRAFT (n=50) CONTROL (n=25) Worst Eye presenting VA1.3 ± ± 0.1<0.001 Worst Eye PH VA1.2 ± ± 0.1<0.001 Best Eye presenting VA0.6 ± ± 0.1<0.001 Best Eye PH VA0.4 ± ± 0.1<0.001 Surgical Eye VA Mean LogMAR ± SD Presenting: 1.3 ± 0.5 Pin hole: 1.2 ± 0.5 9

Table 3: Visual Function Questionnaires VF-14: Visual Function-14 item, CSS-5: Cataract Symptom Scale-5 item Questionnaire (range of possible scores) Mean Score ± SD GroupP value CORNEAL GRAFT (n=50) CONTROL (n=25) Actual VF-14 (0-100)57.8 ± ± 3.8<0.001 CSS-5 (0-15)4.4 ± ± 0.3<0.001 Vision loss last month (0-3)0.9 ± ± Discomfort in eyes last month (0-3)0.8 ± ± 1.0NS Pain in eyes last month (0-3)0.6 ± ± Problems with vision % (n)Little or none16 (8)100 (25)<0.001 Moderate or great deal84 (42)0 (0) Satisfaction with vision % (n)Satisfied18 (9)92 (23)<0.001 Dissatisfied82 (41)8 (2) 10

Table 4: Quality of Life Questionnaires SF-36 (Short Format health survey), EQ5D (EuroQol) Questionnaire (range of possible scores) Mean Score ± SD GroupP value CORNEAL GRAFT (n=50) CONTROL (n=25) SF-36 (0-100)Physical health 48.0 ± ± 10.4 NS Mental health 50.4 ± ± Comorbidities (0-42) 7.2 ± ± 5.4 NS EQ5D (0-1) 0.8 ± ± Depression (0-15)2.5 ± ±

Discussion In year 2009 and prior to that, the wait time for corneal transplant was unacceptably long. The wait time presented here does not reflect the period that new referrals waited to be seen by the cornea specialist. The results of this pilot study will serve to calculate sample sizes for a future multicenter study on wait time for corneal transplantation in Canada. These results helped in advocacy to improve access to donor corneas. The government of Quebec has taken steps to overcome the wait time issue for corneal transplantation. Currently, the wait time is estimated to be between 3-6 months. 12