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PURPOSE: To assess patient expectation, visual improvement, and patient satisfaction after macular hole surgery. METHODS: Fifty-three consecutive patients completed a self-administered questionnaire after macular hole surgery. Responses for expectation of visual improvement before surgery and subjective visual assessment after surgery were scored from 0 to 10 (0 = no improvement in vision, 10 = full improvement). Visual acuity was measured using Snellen charts and converted to logMAR equivalent for statistical analysis. Wilcoxon and Mann-Whitney U tests were performed using the Minitab statistical software program; p < 0.05 was considered significant. RESULTS: Thirty-eight (71%) patients were satisfied with the outcome, 14 (26%) were not, and 1 was uncertain. Both satisfied and dissatisfied patients had no difference in baseline preoperative best-corrected visual acuity (BCVA; 6/60 and 6/60, respectively). There was also no significant difference in median postoperative BCVA between both groups (6/24 and 6/29, respectively, p = 0.6). In satisfied patients, median vision expectation score of 6 was equally similar to the median subjective postoperative vision improvement score of 6, p = 0.7. However, in dissatisfied patients, median vision expectation score (8) was significantly higher than median postoperative subjective vision improvement score (1), p = 0.0001. The commonest reason for dissatisfaction was perceived visual reduction (7/14 patients). CONCLUSIONS: In the dissatisfied patients, expectation was significantly higher, and subjective assessment of vision after surgery was lower than in satisfied patients, although they had similar improvement in BCVA. Visual acuity and patient satisfaction are not always directly correlated. An important factor in patient satisfaction is expectation.

Original publication




Journal article


Optometry and vision science : official publication of the American Academy of Optometry

Publication Date





312 - 316


Birmingham and Midland Eye Centre, City Hospital, Birmingham, United Kingdom.


Humans, Retinal Perforations, Ophthalmologic Surgical Procedures, Postoperative Period, Questionnaires, Prospective Studies, Eyeglasses, Visual Acuity, Aged, Patient Satisfaction, Female, Male