In 2007, the American Academy of Ophthalmology (AAO) sponsored the "Ask a Doctor" and "Medical Eye Support Community" eye-care forums at http://www.MedHelp.org/. The two forums receive more than 3 million visits per year. Posted questions are answered by Sandy Feldman, MD, Ray Oyakawa, MD, and the authors of this article. In 2008, the four of us collectively answered 9,006 individual postings and a much larger number of follow-up questions and discussions.

We conducted a retrospective study of all http://MedHelp.org/ cataract surgery eye forum postings between Nov. 1, 2007, and May 2, 2008. (First literature report—Missouri Medicine 2009:106;73-77). We retrieved 751 postings using key words and excluded all those with pathology other than cataracts. This left 341 discussion threads that we individually reviewed, noting complaints.

We found that in every initial posting the patient was dissatisfied with some aspect of cataract surgery. Most people did not specify the type of IOL inserted in their eye. When they did state it was a monofocal IOL there were 30 complaints compared with 206 complaints (6.87 times more) with presbyopia-correcting IOLs. These complaints were: refractive multifocal IOL (94) (ReZoom, Abbott Medical Optics), apodized diffractive IOL (50) (ReStor, Alcon Laboratories), accommodating IOL (45) (Crystalens, Bausch & Lomb), and unspecified presbyopia-correcting IOL (15).

These studies are retrospective and have no controls. Our first study demonstrated conclusively that Internet eye forums attract dissatisfied patients at least for the initial postings. We recognize this selection bias. These studies in no way represent overall patient satisfaction. Nevertheless, the study of relative frequency of complaints is useful. One of the most common complaints is that the surgeon failed to spend time with the patient, did not answer their questions, or explain their problems.

Our studies suggest that presbyopia-correcting IOLs generate about 60 times more Internet eye forum complaints than monofocal IOLs, given their relative frequency of use (~9:1). The accommodating and apodized diffractive IOLs had similar numbers of patients' complaints and the highest number of happy patients, whereas the refractive multifocal IOL had the highest number of patient complaints and the lowest number of happy patients.

With the introduction of the fourth-generation accommodating IOL (Crystalens HD, Bausch & Lomb) and the latest apodized diffractive IOL (AcrySof IQ ReStor, Alcon Laboratories), we feel that 2009 postings of patient complaints have diminished but that the older technology of IOLs remains problematic and patients symptomatic.

John C. Hagan III, MD, is editor of the Missouri Medical journal and in private practice in Kansas City, MO. He can be reached by phone at 816/478-1230 or e-mail at jhagan@bizkc.rr.com
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Michael J. Kutryb, MD, is in private practice in Titusville, FL. Neither has a financial interest in the subject matter.

References

1. Hagan JC 3rd, Kutryb MJ. Cataract and intraocular implant surgery concerns and comments posted at two Internet eye-care forums. Missouri Medicine. 2009;106:78-82.

2. Hagan III JC, Kutryb MJ. Internet forums track patients' IOL concerns. Review of Ophthalmology. April 2009;52-55.

3. Hagan JC 3rd. Oh say can you see? Using Internet health forums to study cataract surgery. Missouri Medicine. 2009;106:4-5.

4. "Premium IOLS: Optimizing outcomes." EyeNet. February 2009;39-42.

5. "Internet advice: When patients go online." EyeNet May 2009.