Exploring Vision-Related Quality of Life: A Qualitative Study Comparing Patients’ Experience of Cataract Surgery with a Standard Monofocal IOL and an Enhanced Monofocal IOL

Figures & data

Table 1 Characteristics of Participants by Group

	Total (n = 19)	Waiting List (n = 7)	Standard IOL (n = 6)	Enhanced IOL (n = 6)
Age, in years, mean (standard deviation)	74.9 (6.82)	73.9 (6.2)	75.7 (8.4)	82.4 (6.9)
Gender
Women, n (%)	12 (63.16)	6 (85.71)	4 (66.67)	2 (33.33)
Men, n (%)	7 (36.84)	1 (14.29)	2 (33.33)	4 (66.67)
Education level
Without or only primary studies, n (%)	6 (31.58)	3 (42.86)	1 (16.67)	2 (33.33)
Secondary studies, n (%)	8 (42.10)	3 (42.86)	1 (16.67)	4 (66.67)
Higher studies, n (%)	5 (26.31)	1 (14.28)	4 (66.66)	0 (0.00)
Born in the same city where currently living, n (%)	4 (21.05)	1 (14.28)	2 (33.33)	1 (16.67)
Marital status, n (%)
Married, n (%)	13 (68.42)	5 (71.44)	2 (33.33)	6 (100.00)
Separated or divorced, n (%)	3 (15.79)	1 (14.28)	2 (33.33)	0 (0.00)
Widow, n (%)	2 (10.53)	1 (14.28)	1 (16.67)	0 (0.00)
Religious, n (%)	1 (5.26)	0 (0.00)	1 (16.67)	0 (0.00)
Living alone, n (%)	1 (5.26)	1 (14.28)	0 (0.00)	0 (0.00)

Note: n=number of participants.

Table 2 Performance of Tasks in the Near Visual Range Before the Surgery

Task	Verbatim	Participant
Threading a needle	“If I start sewing something I like, threading a needle is a mess. I mean … it’s an uphill climb to me. That’s probably what I find most difficult.”	Woman, 68, waiting list, secondary studies
Taking fine measurements	“When I had to take fine measures … or connect cables”	Man, 71, enhanced IOL, secondary studies
Use tools (screwdriver, hammer, pliers, etc) to fix and/or adjust small objects	“If a radio or a watch is ruined … o some mechanical staff … I have fun with it. But I need more light, because when there is not much light you don’t see it well”	Man, 75, enhanced IOL, secondary studies
	“Screws … it’s a handicap. I created strategies like picking up a magnifying glass. But to pick up a screw and look what kind of screwdriver you need … it was difficult”	Man, 68, enhanced IOL, secondary studies
Do activities related to personal care (shaving, cutting nails, making up)	“What I noticed more is that I needed a lot of light from the very near distance, and very powerful, to do some things … shaving, for example”	Man, 75, enhanced IOL, secondary studies
Read medication and/or nutritional labels, price tags and/or expiration dates on products	“I go shopping with him (husband). The prices … he tells me because I can’t see them well.”	Woman, 85, waiting list, without studies
	“The most difficult thing is when I go shopping. Labels that are sometimes interesting to look at, sugar … this is the most difficult. More than reading a book or looking at the mobile phone.”	Woman, 68, waiting list, secondary studies
Enjoy reading books, journals and/or newspapers	“I wish I could read better clearer. Now all the letters come together.”	Woman, 85, waiting list, without studies
	“When you have to read 500 or 1.000 pages … after two hours with your eyes fixed in the book … it was difficult, much more than before”.	Man, 68, enhanced IOL, secondary studies
	“I just wanted to read after the surgery. Not being able to read … it has been very hard for me (starts crying). … I have not been able to read well … however I have been able to do some small crafts, with some difficulty, but I have to do something in my life because I am an active woman”
	“Reading as I read before, because I really liked reading, both books and magazines, watch television, or sew sometimes, too … I can’t do it because of the eyes.”	Woman, 72, waiting list, secondary studies
	“Even if it is a little, read a little, because immediately my eyes become like they were in tears and cloudy. When I watch the TV, I open and close my eyes again and again, because I need to do it to see, I get an itch … As much in the right eye, which is the one I have got sick, as in the left. Now the left is the one I feel more tired.”

Table 3 Performance of Tasks in the Intermediate Visual Range Before the Surgery

Task	Verbatim	Participant
Use a standard size computer or laptop (to see images, watch videos, read/write e-mails)	“Mid-distance, especially if you are working with a computer … if you cannot see well then it’s a problem … or you go shopping and you cannot see the prices … and that’s important. Up close, reading, for example, is very important … but mid-distance is very important, too … ”	Woman, 69, waiting list, secondary studies
Enjoy hobbies and games within an intermediate distance range (sewing, cross stitch pattern, gardening, playing cards, painting, etc)	“When I start sewing, or reading, I put on my glasses. Otherwise, I couldn’t.”	Woman, 85, waiting list, without studies
	“Sewing … I can’t do it right.”
	“Although I see well up close, it’s hard for me to do cross stitch pattern, and I’ve had to leave it … I couldn’t.”	Woman, 69, waiting list, secondary studies
Feel steady and confident when falling on uneven ground, walk around without fear of falling, climb or descend stairs	“I don’t feel safe when I’m on the street. If there’s a step … I’m careful about that.”	Woman, 68, waiting list, secondary studies
	“I had headache on the street before, because I wasn’t safe”	Woman, 71, enhanced IOL, primary studies
	“There are several things that you have to pay attention to much more than before. For example, walking down the street is what I find most dangerous, if there are slopes … ”	Woman, 68, waiting list, secondary studies
	“Then when you go out … well I am very afraid of falling because you do not see well … I always look at the ground, because if there is a slope you do not see it …”	Woman, 69, waiting list, secondary studies
	“Changes on the surface of the ground … you don’t perceive them with the same sharpness as before”	Man, 68, enhanced IOL, secondary studies
	“If I had better vision, I would go safer, I find myself insecure. What happens to me is that the place where I live, I have got the shop in front of my house, and this is what is useful for me. Going to the first supermarket … I dare more than going to the others, which are two streets further.”	Woman, 72, waiting list, secondary studies
Recognize people you know across the room	“That in the intermediate distance … it was basic … perceive that someone’s coming … and not have to wait at the last moment to greet. And the paddle, the ball … I couldn’t reach it, and I had never arrived late in my life”	Man, 68, enhanced IOL, secondary studies
	“When you saw some in the distance, but until he moved closer like this … I could not see his face sharply”	Man, 68, enhanced IOL, secondary studies
See facial expressions of friends or loved ones	“And it’s the same thing with the faces, sometimes I see a person coming and I know that’s my daughter by the way she moves, but until she’s close I can’t see her face well … it’s difficult for me to distinguish the faces.”	Woman, 69, waiting list, secondary studies
Read subtitles on the TV	“I can still read, but to watch TV, read subtitles … neither.”	Woman, 68, waiting list, secondary studies
	“I used to wear glasses to sew, and that’s all. But it arrived a day that I started to see the TV blurred”	Woman, 71, enhanced IOL, primary studies
	“You’re watching TV, you don’t see the faces well, you can’t read the subtitles, and that makes you nervous”	Woman, 69, waiting list, secondary studies

Table 4 Performance of Tasks in the Distant Visual Range Before the Surgery

Task	Verbatim	Participant
See traffic lights, signals, lines of the road and/or intersections when driving or being inside a car	“When driving, at night, the lines (of the road) … you do not perceive with the same acuity, or if somebody was coming with the light a little bit higher … the blinding was bigger than before … And this last summer, one of the days we went out, it was hazy in the road … until it cleared up, it was an agony for me … because my eyes could not …. and you reduce the speed so much”	Man, 68, enhanced IOL, secondary studies
Drive and/or feel safely in a car (at night, with oncoming lights or bright sunlight, etc)	“And when you’re in the car, as you don’t see well, you have the sensation that the driver sees as bad as you, and this is something that makes me anxious, this is what worries me the most.”	Woman, 69, waiting list, secondary studies
	“Until now, I used to wear glasses for the distant visual range, for example when driving. But lately, when I put on my glasses, they were not very useful, because the cataract prevented me to have a good visual acuity … you put your glasses and you did not achieve the same outcome as before”	Man, 68, enhanced IOL, secondary studies
Participating in outdoor activities without being handicapped by glare	“To do some sports, paddle, specifically. Outdoor, I had to start wearing glasses”	Man, 68, enhanced IOL, secondary studies

Table 5 Changes in the Performance of Vision-Dependent Tasks and Vision-Related Quality of Life Before and After Surgery

Visual Range	Type of Lens	Verbatim	Participant
Near	Standard IOL	“When I went surgery for the left eye, and I looked myself in the mirror. God! How many wrinkles I have … and what a wrinkled face I’ve got …, and I didn’t see it before.”	Woman, 78, without studies
	Enhanced IOL	“And also in the nearby, because if I had to thread a needle … very bad, very bad … Now I don’t see well to do this, because my vision is not enough, but I can still thread with light, and I couldn’t before”	Woman, 84, primary studies
Near, intermediate	Enhanced IOL	“Now, if I go to the supermarket, I see much better the price tags of products. The subtitles of the TV, I also see them better”	Man, 71, secondary studies
Intermediate	Enhanced IOL	“I have noticed a change, most of all in the intermediate distance. In the nearby … I still need glasses, and I do not care about wearing them for the long-distance vision, because they are very specific activities. But I am happy to lead a normal life, without losing time trying to fix the glance o looking for your glasses … at the end you have glasses for the near, glasses for the long … and sometimes they do not adjust”	Man, 68, secondary studies
		“Uneven surfaces … I see them fine now, maybe I had to gaze to them before. If I had to climb or descend stairs, I had to pay much more attention”	Man, 71, secondary studies
		“I was not safe (on the street), because sometimes I was walking”	Woman, 84, primary studies
		“When I went surgery I told the doctor. Wow! You are very handsome! I could not well the faces before”	Woman, 71, primary studies
	Enhanced IOL	“Now I cannot read, nor see the cell phone, nor sewing … because I cannot see in the nearby. But now I see well I see the buses when they are coming, a sign, anything like this, o the faces of people, because before … I saw a person, but I could not identify him. Now I can”	Woman, 71, primary studies
		“For example, when reading digital media. It’s very unusual for me to look for glasses. When I was in the underground, I had to stop in front of the panel of the stations to check if I had to go to the left or to the right. But it was not looking sideways … as I have done all my life … I had to stop, try to locate the station … I mean, paying much more attention, because the vision is not the same. And now it has improved a lot.”	Man, 68, secondary studies
	Enhanced monofocal IOL	“I go dancing. You enter and you see people, but you do not see the faces. I saw the faces before, and also now (after the surgery). It’s very important to enter somewhere and see the faces. Without wearing glasses. I do not like wearing glasses, since I was a child, even if they suits me well … I do not want glasses. I prefer not to have to wear them”	Woman, 71, primary studies
		“The TV … I see it fine. It was not terrible before, but clarity and that … I didn’t see as much. Now much clearer, yes, much clearer.”	Woman, 84, primary studies
		“I don’t need glasses to watch TV now. I see subtitles perfectly”	Woman, 71, primary studies
Intermediate, distant	Enhanced IOL	“If I could have chosen, I had chosen what I’ve been done. Wearing glasses only for nearest things”	Woman, 71, primary studies
Distant	Standard IOL	“After surgery, the vision has improved at the long distance. The difference is that I see clearer now, but not cleaner.”	Woman, 63, higher studies
		“I can see the lines in the road now, well outlined”	Man, higher studies
		“I can sit down and enjoy sightseeing now”	Woman, 68, higher studies
		“See the streets, clearly, the people, the trees, all these things have improved”	Man, 84, secondary studies
	Enhanced IOL	“Now, for the distant vision … I see better than before. I see the same with or without glasses. Before the surgery, they told me that I would not need glasses for the distant vision”	Man, 71, secondary studies
		“I notice more light. And at the long distance, I see better than before”	Man, 75, secondary studies
		“To drive … I see much better than before. Many times I put my glasses like this (points to his forehead) because I don’t need. Before the surgery I felt better wearing glasses”	Man, 71, secondary studies
		“Now I see much more clearer when I drive. I noticed the difference. Traffic signs … perfect”	Man, 68, secondary studies
Overall vision-related quality of life	Enhanced IOL	“I had to turn to my glasses to read anything before, to read very normal things. And now I don’t need glasses. My quality of life had worsen compared to before the cataracts. And now I’ve recovered it”.	Man, 68, secondary studies
		“I had to search how to accommodate my vision all the time … Everybody is very satisfied now, because I’ve recovered part of the quality of life that I had lost”.	Man, 68, secondary studies
		“I do not have any problem to see the cell phone. To watch TV, better, you notice it so much, because I saw double the subtitles, and now I see the perfectly without glasses. With no doubt, for the near, intermediate distance, I see perfectly. At the long distance … I see an antenna at the top of the building in front of my house, and I see it well outlined. Now I see it as well as more than a year before … I mean … fine.”	Man, 75, secondary studies
		“We have to remove the cataract, or whatever, so we can see and have a quality of life that if you could reach it … you can help other people with any problem they have, for example, someone who stops you on the street and tells you … Hey, cannot you look this for me? I cannot see well … ”	Woman, 71, primary studies
		“A whole world … I couldn’t imagine I see so well again … now that I’ve gone on surgery … I don’t remember I could see so fine … you can’t explain it in words”	Woman, 71, primary studies
		“For the daily life of a normal person … it has improved a lot. To read. I saw double before, and I see perfectly now”	Man, 75, secondary studies