• corneal transplantation

In their article in this issue of the BJO (p 57) Saunders and colleagues describe a methodology by which they evaluate the visual health state of patients with severe corneal disease requiring transplantation surgery. Rather than dealing with visual acuity as the only preoperative and outcome parameters, they evaluate patients according to three criteria: (1) visual acuity, (2) ocular pain, and (3) visual function. Concerning the latter criterion, visual function, they utilise a tool called the VFA (visual function assessment),¹ which they have previously described; it is essentially a modification of the VF-14² and predominantly measures ocular function characterised by the ability to perform tasks such as driving, reading, cooking, etc. They found that patients who had a high preoperative priority score, as measured by the three above criteria, were more likely to have a good outcome. One measure in the study that is somewhat unclear, though, is how the results incorporate vision in the eye that did not receive a transplant. All too often our clinical trials and other studies fail to address the status of the second eye, perhaps a factor more important to the patient that the ocular intervention itself. The authors noted that 72.4% of patients demonstrated an improved VFA after transplant, but it is uncertain whether this was measured using only the operated eye or in a real world situation in which both eyes were used during the assessment.

The authors should be congratulated upon bringing more than visual acuity alone into the decision making process. Most ophthalmologists believe …