Quality of life and participation after corneal transplantation and potential predictors: A multicenter prospective cohort study

Purpose: To evaluate the long-term effect of corneal transplantation on health- and vision-related quality of life, visual functioning, and societal participation, and to assess potential predictors. Methods: We conducted a multicenter prospective cohort study in 11 Dutch hospitals and eye clinics. Patients awaiting corneal transplantation (n = 238) completed the Low Vision Quality of Life (LVQOL) questionnaire, Catquest-9SF, Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P), and EuroQol-5 Dimensions (EQ-5D) at baseline and 3, 6, 12, and 24 months post-transplantation. Potential predictors included sociodemographic and clinical characteristics. Linear mixed models analysed changes over time for most outcomes, and generalized estimating equations assessed EQ-5D outcomes. Results: LVQOL subscale scores improved significantly from baseline to 24 months, with large effect sizes (Basic aspects: 44.5 vs. 24.7, p < 0.001; Mobility: 36.0 vs. 18.7, p < 0.001; Adjustment: 24.1 vs. 9.5, p < 0.001; Reading and Fine work: 28.0 vs. 12.2, p < 0.001), as did Catquest scores (57.6 vs. 79.8, p < 0.001). USER-P Restrictions and Satisfaction improved (Restrictions: 83.6 vs. 88.0, p < 0.001; Satisfaction: 68.2 vs. 73.9, p < 0.001), while the Frequency subscale deteriorated (32.7 vs. 29.4, p < 0.001). Effect sizes were all small. The proportion with a perfect EQ-5D score increased (47.7% vs. 56.5%, p = 0.04). Male sex, having work, and Fuchs' dystrophy predicted better outcomes, whereas visual impairment and (dry) eye complaints predicted worse outcomes. Conclusion: Health- and vision-related quality of life, visual functioning, and societal participation are positively impacted by corneal transplantation, and important predictors were identified. The results of this study can be used by ophthalmologists to inform patients about realistic expectations of corneal transplantation.