Expert (medical) evaluation of the main complaints of a patient after cataract phacoemulsiification from the position of a medical and social approach to the study of quality of life: prospective cross-sectional study

BACKGROUND: At present, the study of the quality of life (QOL) of a patient is becoming increasingly important in the practice of cataract surgery, which is associated with the presence of statistically significant correlations between QOL and objective indicators of the visual system. The developed QOL questionnaires for patients with cataracts are based on the medical model of health.

AIM: This study aimed to assess the main complaints of the patient after cataract phacoemulsification (CP) from the standpoint of a medical and social approach to the study of QOL.

MATERIALS AND METHODS: A prospective cross-sectional study was conducted between April 2021 and February 2022. The initial volume of questions (complaints) of the patient was performed in the following areas: before and 3 months after the CP (50 patients with binocular cataract, «visual» manifestations); analysis of the domains of the International Classification of Functioning (ICF, «domestic» manifestations); literary analysis of patient complaints in asthenopic conditions («professional» and «medical-psychological» manifestations); and analysis of the classification structure of the ICF («functional» manifestations). The obtained data were transformed into questions with subsequent analysis by 47 expert ophthalmologists (19.2±1.4 yr of professional experience, including 11.9±1.7 yr of experience in performing CP) from the standpoint of the impact on the patient’s QOL. At the same time, the assessment was carried out on a 10-point scale, according to which of the following: 0 points — the question is irrelevant, 10 points — the question is very relevant. The mathematical analysis of the results was based on the calculation of the basic parameters of descriptive statistics for all 52 questions — the arithmetic mean (AC, as the «weight» coefficient of the question) and the standard deviation (SD, as an indicator of the consistency of the position of the respondents). As a result, the indicator of adjusted relevance (IAR) was calculated according to the formula: IAR = AC/CO. The IAR indicator of at least 2.3 determined the choice of the most relevant responses.

RESULTS: According to expert ophthalmologists, in total (n=52), 21 most pressing issues were identified, mainly «visual» (n=7), «functional» (n=6), and «everyday» (n=5). With regard to the average score of IAR on all the most pressing issues, the leading positions are occupied by «everyday» (average score is 3.20), «visual» (average score is 3.07), and «functional» (average score is 2.63). Thus, the number of «visual» complaints, according to experts, is only one-third of the total relevance, while there is a comparability of the average score of IAR on «visual», «functional», and «everyday» issues.

CONCLUSION: The use of the medico-social model of health provides an increase in the clinical and diagnostic efficiency of assessing the patient’s QOL in cataract surgery. The presented results are basic in the development of an original method for assessing QOL, as they fully comply with the generally accepted requirements for the content and constructive validity of the questionnaire.