2Izmir Tepecik Training and Research Hospital, Department of Ophthalmology, Izmir, Turkey
Materials and Methods: Eighty participants (40 myopia and 40 myopic astigmatism) who have been followed up at our contact lens unit were included. All participants were using both contact lenses and spectacles. The VF-14 questionnaire was used to compare the impacts of contact lenses wearing versus spectacles on daily life.
Results: In myopic participants, the mean VF-14 scores for spectacles and contact lenses were 89.5±18.7 and 96.6±9.3 respectively (p < 0.001). There was a statistically significant difference between spectacles and contact lenses in following activities: watching TV, sports involvement, seeing steps/stairs, playing table games and cooking (p=0.005, p ˂ 0.001, p=0.003, p=0.008, p ˂ 0.001, respectively, paired t tests).
In participants with myopic astigmatism, mean VF-14 scores for spectacles and contact lenses were 88.7±21.8 and 98.3±6.3 respectively (p < 0.001). Statistically significant difference was found between spectacles and contact lenses for the following activities: doing fine handwork, driving at night, watching TV, sports involvement, seeing steps/stairs, playing table games, cooking and recognizing people at distance (p=0.001, p=0.039, p=0.001, p ˂ 0.001, p=0.031, p=0.027, p ˂ 0.001, p=0.023 respectively, paired t tests).
When two groups were compared in terms of all the questions, the VF 14 score was found significantly better in participants wearing contact lenses for the correction of myopic astigmatism during reading small print and doing fine hand work (p=0.002 and p=0.005, respectively; independent sample test).
Conclusions: Wearing contact lenses is more favorable than spectacles in most of daily activities in individuals with mild to moderate myopia and myopic astigmatism. It can improve the quality of life even further in individuals with myopic astigmatism. Keywords: Contact lens; Myopia; Myopic astigmatism; Spectacles; VF-14 questionnaire
Many CL wearers can benefit from toric contact lens correction. If all astigmatism of 0.50 Diopters Cylinder (DC) or more were corrected, 61.5% of wearers would require toric soft contact lens correction. If only astigmatism of 1.00 DC or more was corrected, 34.8% would require toric correction [4].
An indicator of satisfaction from the use of CLs or spectacles is the quality of life among these patients. There are several questionnaires, evaluating quality of life in patients with refractive errors [5-7]. Visual function 14 (VF-14) is a commonly used vision-related functional questionnaire.8 Initially, it was designed to assess vision-related functions in patients undergoing cataract surgery, but it has also been validated for other eye conditions such as glaucoma, retinal, corneal diseases and CLs [9-15]. The VF-14 is easy to administer and to comply with.
The purpose of our study is to evaluate the impact of CLs wear vs. spectacles wear on visual function of young adults with mild to moderate myopia and myopic astigmatism, as they perceive it in their daily life, using the VF-14 questionnaire. We also aimed to evaluate in this study; whether is there a difference between patients with myopia and myopic astigmatism in terms of comfort in daily activities with contact lens wearing.
Following method was used to fit CLs in all participants: Refractive errors were measured with auto refractometer (RKF1; Canon, Tokyo, Japan). Subjective refraction was performed by using a Snellen chart. The lowest myopic and astigmatic values providing patients with best vision were determined. The first trial lens number was determined by substracting the vertex distance value from spectacle correction. After trial fitting CLs were prescribed.
All participants completed the VF-14 questionnaire twice, once for contact lens wear and second for spectacle wear, so as to assess the contact lenses wear vs. spectacles wear impact score on general daily living among the young individuals. It was used as translated in Turkish after following the 'translationback translation' procedure. Participants rate their difficulty in performing daily activities ("No difficulty", "A little difficulty", "A moderate amount of difficulty", "A great deal of difficulty", "Unable to do"). Each question was scored on a scale from 0 (unable to perform an activity at all) to 4 (able to engage in activity fully). The average score was multiplied by 25 to give an overall score ranging from 0 to 100.
The SSPS, version 21.0 (IBM, Chicago, IL, USA) statistical package was used for data analyses. Statistical analyses included the chi-square, independent sample, paired t tests and Mann- Whitney U test. Pearson's correlation analysis was used for correlation between the magnitude of refractive error and VF 14 scores of contact lenses/glasses. A p-value ˂ 0.05 was considered statistically significant.
The meanVF-14 scores for spectacles and contact lenses were 89.5±18.7 and 96.6±9.3 respectively in myopic participants (p < 0.001). There were significant differences between spectacles and contact lenses for following activities: watching TV, sports involvement, seeing steps/stairs, playing table games and cooking. (p=0.005, p ˂ 0.001, p=0.003, p=0.008, p ˂ 0.001; respectively, paired t tests). Whereas, correlation between driving at night and day scores of spectacles and refractive error on VF 14 was significant (r=0.418; p=0.007, r=0.433; p=0.005, respectively, Pearson correlation analysis). The responses of all participants in CLs and spectacles groups are showed in Table 2.
In participants with myopic astigmatism, the mean VF- 14 scores for spectacles and contact lenses were 88.7±21.8 and 98.3±6.3 respectively (p < 0.001). Statistically significant differences were found between spectacles and contact lenses for the following activities: Doing fine handwork, driving at night, watching TV, sports involvement, seeing steps/stairs, playing table games, cooking and recognizing people at distance (p=0.001, p=0.039, p=0.001, p ˂ 0.001, p=0.031, p=0.027, p ˂ 0.001, p=0.023 respectively; paired t tests) (Table 2).
When the myopic and myopic astigmatism groups were compared in terms of all the questions for contact lenses, the VF-14 scores were found significantly better in participants wearing contact lenses for the correction of myopic astigmatism during reading small print or doing fine handwork (p=0.002 and p=0.005, respectively; independent sample test) (Table 3).
Individuals were classified in two groups as female (n=50) and male (n=30) to evaluate the difference on comfort in daily activities between contact lens wearers according to gender. The difference between two groups was not significant in terms of age, spherical equivalent and the duration of contact lens wearing (p=0.236, p=0.516, p=0.157, respectively, Mann-Whitney U test). It was noted that females have higher scores in driving at night, watching TV and seeing steps/stairs with contact lens wearing than males (Table 4).
|
Myopic groups (n=40) |
Myopic astigmatic groups (n=40) |
p value |
Age±SD (years) |
24.0±5.7 |
23.4±4.8 |
0.425* |
Sex (Female:Male) |
13:27 |
16:24 |
0.485** |
Mean spherical equivalant ± SD (D) |
-2.98±1.18 |
-3.38±1.06 |
0.110* |
Mean duration of contact lens wearing±SD (months) |
23.9±29.5 |
20.1±12.6 |
0.462* |
Questions |
Myopia |
Myopic astigmatism |
||||
Mean scores for CL |
Mean scores for spectacle |
p value* |
Mean scores for CL |
Mean scores for spectacle |
p value* |
|
Reading small print |
88.1±14.9 |
92.5±17.1 |
0.227 |
96.8±8.4 |
92.5±15.2 |
0.147 |
Doing fine handwork |
95.6±9.6 |
88.7±19.6 |
0.070 |
100±0.0 |
90.6±15.7 |
0.001 |
Driving at night |
91.3±13.3 |
91.2±18.4 |
1.000 |
96.3±9.0 |
89.4±21.1 |
0.039 |
Reading a newspaper |
97.5±7.6 |
93.7±10.9 |
0.083 |
96.9±8.4 |
94.4±20.0 |
0.486 |
Reading signs |
98.1±6.7 |
97.5±9.6 |
0.711 |
96.9±8.4 |
92.5±15.2 |
0.090 |
Watching TV |
98.1±6.7 |
90.0±14.7 |
0.005 |
98.1±6.7 |
90.0±14.7 |
0.001 |
Sports involvement |
98.7±7.9 |
58.1±25.6 |
˂0.001 |
100±0.0 |
56.3±35.7 |
˂0.001 |
Writing checks/ completing forms |
97.5±7.6 |
96.9±8.4 |
0.743 |
98.8±5.5 |
98.1±6.7 |
0.660 |
Seeing steps/stairs |
98.1±6.7 |
90.6±12.3 |
0.003 |
100±0.0 |
95.0±14.1 |
0.031 |
Playing table games |
98.7±5.5 |
90.6±12.3 |
0.008 |
100±0.0 |
92.5±20.6 |
0.027 |
Reading large print |
100±0.0 |
99.4±3.9 |
0.323 |
100±0.0 |
100±0.0 |
1.000 |
Cooking |
97.5±7.6 |
76.3±21.1 |
˂0.001 |
98.1±6.7 |
68.8±21.7 |
˂0.001 |
Driving during the day |
96.9±10.1 |
92.5±18.9 |
0.227 |
96.3±9.0 |
92.3±15.6 |
0.073 |
Recognising people at distance |
96.3±10.7 |
95.6±10.2 |
0.785 |
98.1±6.7 |
95.0±14.1 |
0.023 |
Statistically significant p values were written in bold.
Questions |
Mean scores for contact lens in myopic groups |
Mean scores for contact lens in myopia astigmatic group |
p value* |
Reading small print |
88.1±14.9 |
96.8±8.4 |
0.002 |
Doing fine handwork |
95.6±9.6 |
100±0.0 |
0.005 |
Driving at night |
91.3±13.3 |
96.3±9.0 |
0.053 |
Reading a newspaper |
97.5±7.6 |
96.9±8.4 |
0.728 |
Reading signs |
98.1±6.7 |
96.9±8.4 |
0.462 |
Watching TV |
98.1±6.7 |
98.1±6.7 |
1.000 |
Sports involvement |
98.7±7.9 |
100±0.0 |
0.320 |
Writing checks/ completing forms |
97.5±7.6 |
98.8±5.5 |
0.402 |
Seeing steps/stairs |
98.1±6.7 |
100±0.0 |
0.079 |
Playing table games |
98.7±5.5 |
100±0.0 |
0.156 |
Reading large print |
100±0.0 |
100±0.0 |
1.000 |
Cooking |
97.5±7.6 |
98.1±6.7 |
0.697 |
Driving during the day |
96.9±10.1 |
96.3±9.0 |
0.771 |
Recognising people at distance |
96.3±10.7 |
98.1±6.7 |
0.349 |
Statistically significant p values were written in bold.
Kanonidouet et al [15] reported that the myopic (mild to moderate) participants were facing more difficulty while they were wearing CLs, while doing fine handwork (i.e. sewing, knitting or carpentry), reading small print/newspapers or driving at night. Contrarily, in our study, no statistically significant difference was found between spectacles and CLs in myopic group while reading small print or doing fine handwork. However, CLs were found significantly superior to spectacles in other daily activities including watching TV, sports involvement, seeing steps/stairs, playing table games or cooking. Wearing CLs for myopic astigmatism was found additionally more comfortable while doing handwork, driving at night and recognizing people at distance. Different results may be a consequence of that all the participants were students in Kanonidou et al's study. Besides, if the difficulty of wearing spectacles during sports or cooking is considered; it is unlikely to get a VF-14 score of 100.
There is no study evaluating the effect of gender on daily activities in contact lens wearers. Our study reveals that contact lens wearing is more comfortable in females in some daily activities (driving at night, watching TV, seeing steps/stairs).
The first reliable questionnaire exclusively administered on patients with ocular disorders was the VF-14 questionnaire developed by Mangione in 1992.17 Initially, it was designed to assess vision-related functioning in patients undergoing cataract surgery, but it has also been validated for use with other eye conditions such as glaucoma, retinal, corneal diseases and contact lenses.9-15 One of the limitations of our study is the fact that we used the VF-14 questionnaire, although the National Eye Institute Refractive Error Quality of Life-42 (NEI RQL-42) has been also designed for the assessment of patients with refractive error.7 But, VF-14 Questionnaire is an easy to understand and short test.
In conclusion, the essential message of our investigation is that the use of both spectacles and contact lenses provide a
Questions |
Mean scores for contact lens in females (n=50) |
Mean scores for contact lens in males (n=30) |
p value* |
Reading small print |
92.0±11.8 |
93.3±14.6 |
0.344 |
Doing fine handwork |
97.5±17.9 |
98.3±6.3 |
0.612 |
Driving at night |
96.5±8.8 |
89.2±14.2 |
0.008 |
Reading a newspaper |
97.0±8.2 |
97.5±7.6 |
0.785 |
Reading signs |
97.5±7.6 |
97.5±7.6 |
1.000 |
Watching TV |
99.5±3.5 |
95.8±8.5 |
0.017 |
Sports involvement |
100±0.0 |
98.3±9.1 |
0.197 |
Writing checks/ completing forms |
98.5±5.9 |
97.5±7.6 |
0.513 |
Seeing steps/stairs |
100±0.0 |
97.5±7.6 |
0.024 |
Playing table games |
99.0±4.9 |
100±0.0 |
0.270 |
Reading large print |
100±0.0 |
100±0.0 |
1.000 |
Cooking |
97.5±7.6 |
98.1±6.3 |
0.612 |
Driving during the day |
96.0±10.5 |
97.5±7.6 |
0.585 |
Recognising people at distance |
97.0±9.6 |
97.5±7.6 |
0.977 |
Statistically significant p values were written in bold.
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