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1 대한안과학회지 2011 년제 52 권제 8 호 J Korean Ophthalmol Soc 2011;52(8): pissn: eissn: DOI : /jkos = 증례보고 = 레이저근시교정술후장기간만족도와삶의질변화 김세경 1 김재훈 1 김응권 1 나경선 2 차흥원 3 현준영 4 조은영 5 정선영 6 장은진 6 김태임 1 연세대학교의과대학안과학교실 1, 가톨릭대학교의과대학안과및시과학교실 2, 울산대학교의과대학안과학교실 3, 서울대학교의과대학안과학교실 4, 강남밝은세상안과 5, 한국보건의료연구원 6 목적 : 설문조사를통하여레이저근시교정술을받은사람들의수술후장기간주관적만족도및삶의질변화에대하여알아보고자하였다. 대상과방법 : 2002 년부터 2005 년사이에 5 개병원 ( 신촌세브란스병원, 서울대학교병원, 서울아산병원, 서울성모병원, 강남밝은세상안과 ) 에서레이저근시교정술을시행받은지 5 년이상경과한 231 명을대상으로수술후만족도및삶의질에관한전화설문조사를실시하고이를분석하였다. 결과 : 수술에대한만족도점수는 10 점만점에평균 8.12 점이었으며삶의질이향상되었다고답한경우가 91% 이었다. 수술을다시받을의향이있다고답한경우는 87.9% 이었으며, 친구나가족에게추천할의향이있다고답한경우는 80.5% 이었다. 수술후가장불편하다고답한안과적증상으로는안구건조증상 (57.1%) 과야간번져보임 (54.3%) 이있었다. 결론 : 레이저근시교정술은수술후장기간이지나도높은환자만족도를보였으며환자들의삶의질향상에도매우효과적이었음을알수있었다. < 대한안과학회지 2011;52(8): > 레이저근시교정술은 1983년 Trokel이굴절교정레이저각막절제술 (photorefractive keratectomy, PRK) 을소개한이후, 라식수술 (laser in situ keratomileusis, LASIK) 그리고라섹수술 (laser assisted sub-epithelial keratomileusis, LASEK) 로발전하면서계속적인기술의발달과경험이축적되고있으며그효과와안정성이널리입증되고있다. 1-4 LASIK은 1990년 Pallikaris et al 5 가도입한이래 PRK에비해동통이경미하고, 회복이빠르며, 각막혼탁이적게발생하는점등의장점이있고, LASEK은 1999년 Camellin에의해소개된이후 PRK에비해경미한통증과빠른회복, LASIK과비교할때각막절편과연관된합병증이적어널리시행되고있다. 5-8 레이저근시교정술이보편화되고발달하면서수술결과에대한기대도점차높아져수술의부작용뿐아니라시력의질적향상및환자만족도, 삶의질변화에대하여많은사회적관심이집중되고있다. 레이저근시교정술의부작용으로야간시번져보임, 후 접수일 : 2011년 1월 6일 게재허가일 : 2011년 5월 6일 심사통과일 : 2011 년 2 월 16 일 책임저자 : 김태임서울시서대문구신촌동 134 연세의대부속세브란스병원안과 Tel: , Fax: tikim@yuhs.ac * 본논문의요지는 2010 년대한안과학회제 104 회학술대회에서포스터로발표되었음. 광현상, 안구건조증등의불편감이많은연구에서보고되고있고, 국내연구결과에서도라식수술후안구건조증, 야간번져보임이가장많은부작용으로보고되고있다 이와같은부작용은실생활에불편함을초래하여시력의질적만족도를저하시킬수있다. 그럼에도불구하고 2003 년 Bailey et al 9 은라식수술후만족도가 82-98% 에이른다고보고하였으며, 최근의한연구에서는 95% 이상의환자에서만족도가높았다는보고도있다. 10 국내에서도레이저굴절교정수술이심리적인만족감, 사회적기능장애해소에따른삶의질향상에기여하는것으로보고된바있다. 11,12 그러나이러한기존의대부분의연구결과들은수술후 1년정도경과한환자들을대상으로한단기적인만족도및삶의질에관한보고들이며, 대규모환자들을대상으로한장기적인연구는아직까지보고된바가없다. 따라서본연구에서는레이저굴절교정수술을받고 5년이상경과된근시환자들을대상으로수술후주관적만족도및삶의질변화와불편한자각증상에대하여의무기록분석과설문조사를통하여알아보고자하였다. 대상과방법 2002년부터 2005년까지 5개병원 ( 신촌세브란스병원, 서울대학교병원, 서울아산병원, 서울성모병원, 강남밝은세 922

2 - 김세경외 : 레이저근시교정술후만족도와삶의질 - 상안과 ) 에서레이저근시교정술을받은 231명을대상으로의무기록분석과전화설문조사를실시하였다. 2002년이전에근시교정술을받은경험이있는경우, 치료적레이저각막절제술을받은경우, 백내장, 녹내장등시력에영향을주는질환을동반한경우, 원시및약시가있던경우, 의무기록이분실되었거나기록이미비한경우, 양안의수술방법이다른경우는연구대상에서제외하였다. 의무기록은환자의성별, 나이, 수술전굴절이상, 수술전동공크기, 수술종류등을분석하였고, 수술전굴절이상을 -6.0D 이하인군과이상인군으로나누어비교분석하였고 4개의영역, 총 26문항으로설문을시행하였다 (Appendix). 설문문항은시력및수술관련 7문항, 수술결과에대한전반적인만족도 3문항, 안과적자각증상 10문항, 심리적상태 6문항으로구성되었다. 시력및수술관련문항은 1) 수술의종류, 2) 수술을받은날짜, 3) 양안혹은단안시행여부, 4) 재수술시행여부, 5) 수술전사용한굴절교정장치종류, 6) 근거리작업시굴절교정장치사용여부, 7) 일상생활시굴절교정장치사용여부로구성하였다. 수술결과에대한전반적인만족도문항은 1) 만족도의주관적인점수 (10점만점 ), 2) 수술을다시받을의향, 3) 친구나가족에게추천할의향으로구성하였다. 안과적자각증상과심리적상태에관련된 16 문항은 근 시관련삶의질측정도구 (Myopia-specific Quality of Life Questionnaire, MQLQ) 를토대로작성되었다. 11 이는엑시머레이저술, 라식과같은굴절교정술후환자의안과적상태및시기능의변화를측정한이전의국내외선행연구들을분석하여근시와관련된기능및삶의질을반영하기위해만들어졌으며, 미국의 National Eye Institute Visual Function Questionnaire (NEI-VFQ) 51문항, Steinberg et al 21 이개발한 Vision Function-14 의 14문항을참조하였다 통계학적분석은통계프로그램 SAS (version 9.1.3, SAS Institute Inc., Cary, NC, USA) 을사용하였으며, 통계학적유의성의기준은 p<0.05 로정의하였다. 결과 231명의대상환자중남자는 42명 (18.2%), 여자는 189 명 (81.8%) 으로, 설문응답시평균연령은 35.7세 (25-53), 수술시평균연령은 29.4세 (20-47) 였다. 양안라식수술을받은사람은 152명 (65.7%), 양안라섹수술또는굴절교정레이저각막절제술 (PRK) 을받은사람은 66명 (28.6%), 단안라식수술을받은사람은 8명 (3.5%), 단안라섹수술또는굴절교정레이저각막절제술을받은사람은 5명 (2.2%) 이었다. 평균수술전굴절이상 (spherical equivalent) 은 Table 1. Patient demographics Mean ± SD * N (%) Sex Male 42 (18.2) Female 189 (81.8) Age at survey (yr) 35.7 ± (12.2) (64.5) (20.3) (3.0) Age at operation (yr) 29.4 ± (57.6) (37.2) (5.2) Type of surgery LASIK in both eyes 152 (65.7) LASEK or PRK in both eyes 66 (28.6) LASIK in one eye 8 (3.5) LASEK or PRK in one eye 5 (2.2) Preoperative refractive error (SE ) -5.0 ± 1.9 <-6.0D 164 (71.0) -6.0D 67 (29.0) Elapsed time after surgery (yr) 6.3 ± and <6 71 (30.7) 6 and <7 72 (31.2) 7 and <8 41 (17.8) 8 and <9 47 (20.3) * SD = standard deviation; SE = spherical equivalent; Based on more myopic eye between both eyes

$- 대한안과학회지 2011 년제 52 권제 8 호 - Table 2. Patient satisfaction after myopic laser refractive surgery Patient satisfaction score (mean ± SD * ) p-value Overall 8.12 ± 1.77 Sex 0.09 Male 7.56 ± 2.$ $88 Preoperative refractive error (SE ) (worse eye) 0.01 <-6.0D 8.31 ± 1.09-6.0D 7.62 ± 1.89 * SD = standard deviation; p-value by t-test; ANOVA test; SE = spherical equivalent. -5.0 ± 1.9 (-1.25~-9.$

3 - 대한안과학회지 2011 년제 52 권제 8 호 - Table 2. Patient satisfaction after myopic laser refractive surgery Patient satisfaction score (mean ± SD * ) p-value Overall 8.12 ± 1.77 Sex 0.09 Male 7.56 ± 2.38 Female 8.25 ± 1.60 Age at operation (yr) ± ± ± 1.32 Type of surgery 0.83 LASIK 8.13 ± 1.73 LASEK or PRK 8.10 ± 1.88 Preoperative refractive error (SE ) (worse eye) 0.01 <-6.0D 8.31 ± D 7.62 ± 1.89 * SD = standard deviation; p-value by t-test; ANOVA test; SE = spherical equivalent ± 1.9 (-1.25~-9.75)Diopter (D) 이었으며, 양안수술을받은환자의경우술전굴절이상이심한눈을기준으로분석하였다. 수술후설문응답시까지의평균경과기간은 6.3 ± 1.11년이었다 (Table 1). 재수술을시행받은사람은 3명 (1.3%) 이었다. 수술후근거리작업시굴절교정장치의사용여부를묻는문항에대해 10명 (4.3%) 이사용한다는응답을하였고, 일상생활시굴절교정장치사용유무에대해서는 25명 (10.8%) 이사용한다고응답하였다. 수술에대한만족도는 10점만점에평균 8.12점이었다. 성별이나수술당시의연령, 수술방법에따른만족도의통계학적유의한차이는없었다. 수술전굴절이상의정도에따른만족도의차이가있는지알아보기위하여환자들을수술전굴절이상 -6.0D 를기준으로나누어분석해보았는데, 수술전굴절이상이 -6.0D 미만인군에서는 8.31점, -6.0D 이상인군에서는 7.62점으로수술전굴절이상이적은군에서통계학적으로유의하게만족도가높았다 (p=0.01) (Table 2). 수술받기전으로돌아간다해도다시수술을받을의향이있다고응답한사람은 203명 (87.9%) 이었고, 수술을다시받을의향이없다고응답한사람은 13명 (5.6%) 이었으며, 잘모르겠다고응답한사람은 15명 (6.5%) 이었다 (Fig. 1). 레이저근시교정수술을친구나가족에게추천할의향이있다고응답한사람은 186명 (80.5%) 이었고, 없다고응답한사람은 21명 (9.1%) 이었으며, 잘모르겠다고응답한사람은 24명 (10.4%) 이었다 (Fig. 2). 심리적상태및만족도에대한설문조사결과에서는, 수술이직업이나경력의이미지향상에도움이되었다고응답한사람은 171명 (74.0%), 외모개선에도움이되었다고응답한사람은 185명 (80.1%), 대인관계에도움이되었다고응답한사람은 168명 (72.7%), 수술후자신감이향상 5.6% 6.5% 87.9% Yes No Unsure Figure 1. Intention of receiving myopic laser refractive surgery again. 9.1% 10.4% 80.5% Yes No Unsure Figure 2. Recommend myopic laser refractive surgery to a friend or family. 되었다고응답한사람은 192명 (83.1%) 으로조사되었다. 향후시력이나빠질까봐걱정된다고응답한사람은 147명 (63.6%) 이었으며, 수술후삶의질이향상되었다고응답한사람은 211명 (91.3%) 이었다 (Fig. 3). 안과적자각증상에대해서는기존에레이저굴절교정술후흔히발생할수있는증상들로알려진안구건조, 야간빛번짐, 후광, 눈부심등을조사하였다 조사결과가장많은환자에서나타난증상은안구건조증상으로서 133명 (57.1%) 에서호소하였고, 그다음으로는야간번져보임이 129명 (54.3%) 에서나타났다. 눈부심은 103명 (44.3%), 안구 924

4 - 김세경외 : 레이저근시교정술후만족도와삶의질 - 충혈및통증은 91명 (39.1%), 눈의시림은 89명 (38.2%), 후광은 72명 (30.9%) 에서있다고응답하였다 (Fig. 4). 수술전굴절이상정도에따른수술후자각증상의차이가있는지를분석해보았는데, 수술전굴절이상이 -6.0D 미만인군에서는 10가지증상중적어도한가지증상이있다고응답한사람이 84.1%, -6.0D 이상인군에서는 94.0% 로수술전굴절이상이 -6.0D 이상인군에서많았으나통계학적으로유의하지는않았다 (p=0.05). 겹쳐보이거나둘로보임증상은 -6.0D 미만인군에서는 21.3%, -6.0D 이상인군에서는 47.8% 로 -6.0D 이상인군에서통계학적으로유의하게많이나타났다 (p<0.001). 통계학적으로유의하지는않았지만, 안구건조증상은 -6.0D 미만인군에서는 53.0%, -6.0D 이상인군에서는 65.7% 에서호소하였고, 야간번져보임은 -6.0D 미만인군에서 53.0%, -6.0D 이상인군에서 61.2% 에서호소하였다. 그외다른증상들모두 -6.0D 이상인군에서 -6.0D 미만인군에비해더많은수의환자들이있다고응답하였다 (Table 3). 수술방법의종류에따른자각증상을살펴보면안구건조증상은라식을시행받은군에서는 55%, 라섹또는굴절교정레이저각막절제술을시행받은군에서는 60.6% 에서있다고응답하였고두군간에통계학적유의한차이는없었다 (p=0.80). 야간번져보임은라식을시행받은군에서는 60.6%, 라섹또는굴절교정레이저각막절제술을시행받은군에서는 43.7% 에서호소하였지만이역시두군간에통계학적유의한차이는없었다 (p=0.11) (Table 4). Career image 74 Double vision Halo Apperance Interpersonal relations Glare Night blurring Blurred vision Self-confidence Worrying about future eyesight Improvement of quality of life Yes No Unsure Redness, pain Dryness Eye discharge Color distinction Eye soreness Yes No Figure 3. Satisfaction about psychological well-being after myopic laser refractive surgery. Figure 4. Visual discomfort after myopic laser refractive surgery. Table 3. Comparison of visual discomfort after myopic laser refractive surgery Preop. * SE <-6.0D (n = 164) Preop. * SE -6.0D (n = 67) N (%) N (%) p-value Double vision 35 (21.3) 32 (47.8) <0.001 Halo 47 (28.7) 23 (34.3) 0.43 Glare 65 (39.6) 36 (53.7) 0.06 Night blurring 87 (53.0) 41 (61.2) 0.24 Blurred vision 38 (23.2) 24 (35.8) 0.07 Redness, pain 58 (35.4) 30 (44.8) 0.23 Dryness 87 (53.0) 44 (65.7) 0.11 Eye discharge 43 (26.2) 25 (37.3) 0.11 Color distinction 1 (0.6) 2 (3.0) 0.21 Eye soreness 57 (34.8) 31 (46.3) 0.14 At least one of these symptoms 138 (84.1) 63 (94.0) 0.05 * Preop. = preoperative; SE = spherical equivalent. Table 4. Comparison of visual discomfort after myopic laser refractive surgery LASIK (n = 160) N (%) LASEK or PRK (n = 71) N (%) p-value Dryness Yes 88 (55%) 43 (60.6%) 0.80 Night blurring Yes 97 (60.6%) 31 (43.7%)

5 - 대한안과학회지 2011 년제 52 권제 8 호 - Table 5. Spearman correlation coefficients between visual discomfort and pupil size Night blurring p-value Halo p-value Pupil diameter * Pupil diameter * -ablation zone size * Mesopic pupil diameter. 환자의수술후자각증상중야간번져보임과후광은암순응상태에서의동공크기그리고동공크기에서연마된광학부크기 (ablation zone size) 를뺀값과상관관계가있는지분석해보았는데, 야간번져보임과후광모두동공크기나동공크기에서연마된광학부크기를뺀값과통계학적으로유의한상관관계는보이지않았다 (Table 5). 고찰 본연구는국내에서레이저근시교정술후 5년이상장기경과된환자들을대상으로만족도에대해연구해보았다. 레이저근시교정술의장기적만족도는수술후 5년이상이경과하여도 10점만점에평균 8.12점으로비교적높게나타났으며, 수술전굴절이상이적은군에서만족도가유의하게높은것으로나타났다. 수술전굴절이상이 -6.0D 미만인군에서 -6.0D 이상인군에비해안구건조증, 야간번져보임등의불편한자각증상을적게호소하였는데, 이러한증상들이만족도와관련이있을것으로생각한다. 이것은술전굴절이상이클수록수술후눈부심, 후광과같은합병증이나타나는빈도가높다는기존의보고들과도일치하는결과이다. 9,15,24 또한레이저근시교정술은외모에대한자신감을향상시키는등심리적인면에서도만족스러운결과를보인다고많이보고되고있는데, 본연구에서도대다수의환자들이수술후 5년이상경과하여도여전히만족하고있는것으로나타났으며, 특히 91.3% 의많은환자에서삶의질이향상되었다고응답하였다. 이는수술후향상된나안시력이안경이나콘택트렌즈를착용하는것보다일상생활하는데불편함을줄여서삶의질을높이는데기여하는것으로생각한다. 레이저근시교정술의야간불편감이나후광, 눈부심등의시력의질과관련된부작용은여러연구에서 12-57% 까지다양하게보고되고있다. 9,15,16,29-32 또한안구건조증도수술후흔히나타나는합병증중의하나로수술후환자불만족의흔한원인으로보고되고있는데, 수술후 5년이상이지나도가장많이호소하는안과적자각증상역시안구건조증상 (57.1%) 과야간불편감 (54.3%) 으로본연구결과나타났다. 야간불편감은동공으로들어온빛이동공의가장자리에서일으키는회절현상, 고위수차, 구면수차, 난시굴절이 상, 각막혼탁으로인한빛의산란, 각막중심부위의융기, 잔여근시등의복합적인원인으로인해발생하는것으로알려져있다 따라서동공크기가야간불편감과관련이있어한때동공크기가클수록후광, 야간번져보임이심하다는보고가많았다. 24,41-43 하지만, 최근에는동공크기와관계없다는연구결과들도많이보고되고있다. 9,14,15,17,18,29,30,39,44 본연구결과에서도후광과야간번져보임모두동공크기와상관관계가없는것으로나타났다. 하지만본연구에서는 5개의병원에서후향적으로의무기록을분석하는방법으로자료를수집한것이기때문에수술전후동공크기측정방법에있어병원간에일관성이결여되어있을수있고이는본연구의제한점으로생각한다. 레이저근시교정술후발생하는안구건조증은시력의질저하와눈의불편감과관련이있는데, 수술후발생하는안구건조증의원인기전으로는신경영양물질분비에의한각막환경변화, 눈물분비감소, 눈물층의안정성저하, 눈물증발증가, 각막윤부술잔세포의손상, 라식수술의경우각막감각신경의절단으로인한각막지각감소등이알려져있다 ,45-47 수술후유발되는안구건조증이굴절교정레이저각막절제술과라식수술에서차이가있는지에대한연구가이미많이있었는데, 라식수술이수술후 3개월까지는 PRK에비해안구건조증을더심하게유발하였으나 6개월이후에는두수술간에차이가없다고나타났었다 본연구에서도라식수술을시행받은군과 PRK 또는라섹수술을시행받은군에서안구건조증상의통계학적유의한차이는없었다. 수술후안구건조증상의악화를방지하여만족도를더욱높이기위해서는레이저근시교정술을시행하기전에자세한병력청취, 눈물막파괴시간측정, 쉬르머검사등을시행하여안구건조증을미리진단하고치료하는것이도움이된다. 52 본연구는전화설문조사를통하여국내레이저근시교정술의장기적만족도를평가하였는데, 환자의현재굴절이상정도, 눈물막파괴시간측정이나쉬르머검사를통한객관적인안구건조상태등수술후상태에관한정보가부족하여만족도와관련있는여러인자들을분석하는데한계점이있었다. 추후전향적인연구를통한수술후만족도변화조사및수술후경과기간에따른변화를분석해보는것이레이저근시교정술의장기적결과확인에더욱도움이될것으로생각하며, 이번연구에서나타난수술후불편 926

6 - 김세경외 : 레이저근시교정술후만족도와삶의질 - 증상들과관련된요소들의위험인자들을좀더찾아보고연구해보는것또한필요할것으로생각한다. 그리고최근새로운수술방법들이소개되고시행되고있는데, 이에대한장기적수술만족도에대한연구역시앞으로필요할것이다. 본연구는국내에서최초로레이저근시교정술의장기만족도를대규모로조사한것으로그의의가있으며, 결론적으로수술후장기간이지난후에도환자들의만족도는우수하였고삶의질향상에도매우효과적이었음을알수있었다. 참고문헌 1) Trokel SL, Srinivasan R, Braren B. Excimer laser surgery of the cornea. Am J Ophthalmol 1983;96: ) Ambrósio R Jr, Wilson S. LASIK vs LASEK vs PRK: advantages and indications. Semin Ophthalmol 2003;18: ) Aizawa D, Shimizu K, Komatsu M, et al. Clinical outcomes of wavefront-guided laser in situ keratomileusis: 6-month follow-up. J Cataract Refract Surg 2003;29: ) Knorz MC, Liermann A, Seiberth V, et al. Laser in situ keratomileusis to correct myopia of to diopters. J Refract Surg 1996;12: ) Pallikaris IG, Papatzanaki ME, Stathi EZ, et al. Laser in situ keratomileusis. Lasers Surg Med 1990;10: ) Dastjerdi MH, Soong HK. LASEK (laser subepithelial keratomileusis). Curr Opin Ophthalmol 2002;13: ) Anderson NJ, Beran RF, Schneider TL. Epi-LASEK for the correction of myopia and myopic astigmatism. J Cataract Refract Surg 2002;28: ) Litwak S, Zadok D, Garcia-de Quevedo V, et al. Laser-assisted subepithelial keratectomy versus photorefractive keratectomy for the correction of myopia. A prospective comparative study. J Cataract Refract Surg 2002;28: ) Bailey MD, Mitchell GL, Dhaliwal DK, et al. Patient satisfaction and visual symptoms after laser in situ keratomileusis. Ophthalmology 2003;110: ) Solomon KD, Fernández de Castro LE, Sandoval HP, et al. LASIK world literature review: quality of life and patient satisfaction. Ophthalmology 2009;116: ) Lee JH, Lee JM, Park GH, et al. Impact of laser in situ keratomileusis (LASIK) treatment on quality of life in myopia patients. J Korean Ophthalmol Soc 2003;44: ) Park KS, Kim HC, Lim SM, et al. Comparison of patient satisfaction between conventional and customized LASIK. J Korean Ophthalmol Soc 2006;47: ) Nuijts RM, Nabar VA, Hament WJ, Eggink FA. Wavefront-guided versus standard laser in situ keratomileusis to correct low to moderate myopia. J Cataract Refract Surg 2002;28: ) Schallhorn SC, Kaupp SE, Tanzer DJ, et al. Pupil size and quality of vision after LASIK. Ophthalmology 2003;110: ) Pop M, Payette Y. Risk factors for night vision complaints after LASIK for myopia. Ophthalmology 2004;111: ) Hammond SD Jr, Puri AK, Ambati BK. Quality of vision and patient satisfaction after LASIK. Curr Opin Ophthalmol 2004;15: ) Lee YC, Hu FR, Wang IJ. Quality of vision after laser in situ keratomileusis: influence of dioptric correction and pupil size on visual function. J Cataract Refract Surg 2003;29: ) Tuan KM. Visual experience and patient satisfaction with wavefront-guided laser in situ keratomileusis. J Cataract Refract Surg 2006;32: ) Sugar A, Rapuano CJ, Culbertson WW, et al. Laser in situ keratomileusis for myopia and astigmatism: safety and efficacy: a report by the American Academy of Ophthalmology. Ophthalmology 2002;109: ) Hersh PS, Steinert RF, Brint SF. Photorefractive keratectomy versus laser in situ keratomileusis: comparison of optical side effects. Summit PRK-LASIK Study Group. Ophthalmology 2000;107: ) Steinberg EP, Tielsch JM, Schein OD, et al. The VF-14. An index of functional impairment in patients with cataract. Arch Ophthalmol 1994;112: ) Mangione CM, Berry S, Spritzer K, et al. Identifying the content area for the 51-item National Eye Institute Visual Function Questionnaire: results from focus groups with visually impaired persons. Arch Ophthalmol 1998;116: ) Mangione CM, Lee PP, Pitts J, et al. Psychometric properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ). NEI-VFQ Field Test Investigators. Arch Ophthalmol 1998;116: ) Moreno-Barriuso E, Lloves JM, Marcos S, et al. Ocular aberrations before and after myopic corneal refractive surgery: LASIK-induced changes measured with laser ray tracing. Invest Ophthalmol Vis Sci 2001;42: ) Kahle G, Seiler T, Wollensak J. Report on psychosocial findings and satisfaction among patients 1 year after excimer laser photorefractive keratectomy. Refract Corneal Surg 1992;8: ) Powers MK, Meyerowitz BE, Arrowsmith PN, Marks RG. Psychosocial findings in radial keratotomy patients two years after surgery. Ophthalmology 1984;91: ) Chen CY, Keeffe JE, Garoufalis P, et al. Vision-related quality of life comparison for emmetropes, myopes after refractive surgery, and myopes wearing spectacles or contact lenses. J Refract Surg 2007;23: ) Pesudovs K, Garamendi E, Elliott DB. A quality of life comparison of people wearing spectacles or contact lenses or having undergone refractive surgery. J Refract Surg 2006;22: ) Tahzib NG, Bootsma SJ, Eggink FA, et al. Functional outcomes and patient satisfaction after laser in situ keratomileusis for correction of myopia. J Cataract Refract Surg 2005;31: ) Brunette I, Gresset J, Boivin JF, et al. Functional outcome and satisfaction after photorefractive keratectomy. Part 2: survey of 690 patients. Ophthalmology 2000;107: ) Brown SM, Khanani AM. Night vision complaints after LASIK. Ophthalmology 2004;111: ) Salz JJ, Boxer Wachler BS, Holladay JT, Trattler W. Night vision complaints after LASIK. Ophthalmology 2004;111: ) Wilson SE, Ambrósio R. Laser in situ keratomileusis-induced neurotrophic epitheliopathy. Am J Ophthalmol 2001;132: ) Savini G, Barboni P, Zanini M, Tseng SC. Ocular surface changes in laser in situ keratomileusis-induced neurotrophic epitheliopathy. J Refract Surg 2004;20: ) Vroman DT, Sandoval HP, Fernández de Castro LE, et al. Effect of hinge location on corneal sensation and dry eye after laser in situ keratomileusis for myopia. J Cataract Refract Surg 2005;31:

7 - 대한안과학회지 2011 년제 52 권제 8 호 - 36) De Paiva CS, Chen Z, Koch DD, et al. The incidence and risk factors for developing dry eye after myopic LASIK. Am J Ophthalmol 2006;141: ) Mian SI, Shtein RM, Nelson A, Musch DC. Effect of hinge position on corneal sensation and dry eye after laser in situ keratomileusis using a femtosecond laser. J Cataract Refract Surg 2007;33: ) Fan-Paul NI, Li J, Miller JS, Florakis GJ. Night vision disturbances after corneal refractive surgery. Surv Ophthalmol 2002;47: ) Villa C, Gutiérrez R, Jiménez JR, González-Méijome JM. Night vision disturbances after successful LASIK surgery. Br J Ophthalmol 2007;91: ) Lackner B, Pieh S, Schmidinger G, et al. Glare and halo phenomena after laser in situ keratomileusis. J Cataract Refract Surg 2003; 29: ) Bullimore MA, Olson MD, Maloney RK. Visual performance after photorefractive keratectomy with a 6-mm ablation zone. Am J Ophthalmol 1999;128: ) Haw WW, Manche EE. Effect of preoperative pupil measurements on glare, halos, and visual function after photoastigmatic refractive keratectomy. J Cataract Refract Surg 2001;27: ) Boxer Wachler BS, Huynh VN, El-Shiaty AF, Goldberg D. Evaluation of corneal functional optical zone after laser in situ keratomileusis. J Cataract Refract Surg 2002;28: ) Schallhorn SC, Tanzer DJ, Kaupp SE, et al. Comparison of night driving performance after wavefront-guided and conventional LASIK for moderate myopia. Ophthalmology 2009;116: ) Lee HK, Lee KS, Kim HC, et al. Nerve growth factor concentration and implications in photorefractive keratectomy vs laser in situ keratomileusis. Am J Ophthalmol 2005;139: ) Tuisku IS, Lindbohm N, Wilson SE, Tervo TM. Dry eye and corneal sensitivity after high myopic LASIK. J Refract Surg 2007;23: ) Salomão MQ, Ambrósio R Jr, Wilson SE. Dry eye associated with laser in situ keratomileusis: Mechanical microkeratome versus femtosecond laser. J Cataract Refract Surg 2009;35: ) Lee JB, Ryu CH, Kim J, et al. Comparison of tear secretion and tear film instability after photorefractive keratectomy and laser in situ keratomileusis. J Cataract Refract Surg 2000;26: ) Nejima R, Miyata K, Tanabe T, et al. Corneal barrier function, tear film stability, and corneal sensation after photorefractive keratectomy and laser in situ keratomileusis. Am J Ophthalmol 2005;139: ) Pérez-Santonja JJ, Sakla HF, Cardona C, et al. Corneal sensitivity after photorefractive keratectomy and laser in situ keratomileusis for low myopia. Am J Ophthalmol 1999;127: ) Matsui H, Kumano Y, Zushi I, et al. Corneal sensation after correction of myopia by photorefractive keratectomy and laser in situ keratomileusis. J Cataract Refract Surg 2001;27: ) Ambrósio R Jr, Tervo T, Wilson SE. LASIK-associated dry eye and neurotrophic epitheliopathy: pathophysiology and strategies for prevention and treatment. J Refract Surg 2008;24: Appendix. The questionnaire 928

8 - 김세경외 : 레이저근시교정술후만족도와삶의질 - =ABSTRACT= Long-Term Quality of Life after Myopic Laser Refractive Surgery Se Kyung Kim, MD 1, Jae Hoon Kim, MD 1, Eung Kweon Kim, MD, PhD 1, Kyung Sun Na, MD 2, Hungwon Tchah, MD 3, Joon Young Hyon, MD 4, Eun Young Cho, MD 5, Sun Young Jung, PhD 6, Eun Jin Jang, PhD 6, Tae Im Kim, MD, PhD 1 The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine 1, Seoul, Korea Department of Ophthalmology and Visual Science, The Catholic University of Korea School of Medicine 2, Seoul, Korea Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine 3, Ulsan, Korea Department of Ophthalmology, Seoul National University College of Medicine 4, Seoul, Korea BS Eye Center 5, Seoul, Korea National Evidence-based Healthcare Collaborating Agency 6, Seoul, Korea Purpose: To investigate long-term satisfaction and quality of life after myopic laser refractive surgery. Methods: This study included 231 myopic patients who underwent laser refractive surgery (LASIK, LASEK or PRK) at least five years prior, between 2002 and 2005, at 5 hospitals. Using a telephone survey, patients were asked to subjectively answer 26 questions regarding satisfaction, quality of life changes, and visual symptoms. Results: The mean patient satisfaction score was 8.12 (scale of 1 to 10). Improvement in quality of life was reported by 91% of the subjects. Intention to have surgery again was reported by 87.9% of the subjects and intention to recommend refractive surgery to a friend or family was reported by 80.5% of the subjects. The most common discomfort symptoms after myopic laser refractive surgery were dry eye symptoms (57.1%), followed by night vision disturbances (54.3%). Conclusions: Long-term satisfaction and quality of life were shown to be positive in patients treated with myopic refractive surgery. J Korean Ophthalmol Soc 2011;52(8): Key Words: Laser refractive surgery, Long-term satisfaction, Quality of life Address reprint requests to Tae Im Kim, MD, PhD Department of Ophthalmology, Yonsei University Severance Hospital #134 Sinchon-dong, Seodaemun-gu, Seoul , Korea Tel: , Fax: , tikim@yuhs.ac 929

<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770>

<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770> 대한안과학회지 제 49 권 제 5 호 2008 J Korean Ophthalmol Soc 49(5):727-731, 2008 DOI : 10.3341/jkos.2008.49.5.727 다초점 소프트콘택트렌즈의 노안의 시력보정에 대한 유용성 평가 김현경 1 김효명 2 정성근 1 가톨릭대학교 의과대학 성모병원 안과학교실 1, 고려대학교 의과대학 안암병원 안과학교실