From London Vision Clinic, London, United Kingdom; the Department of Ophthalmology, St Thomas’ Hospital – Kings College, London, United Kingdom; the Department of Weill Medical College of Cornell University, New York, NY; Centre Hospitalier National d’Ophtalmologie, Paris, France (Reinstein); and InView, Atlanta, Ga (Waring).
A simple internet search using search terms such as “refractive surgery outcomes analysis software” will readily provide links to current commercially available software packages.
Correspondence: Dan Z. Reinstein, MD, London Vision Clinic, 138 Harley St, London W1G 7LA, United Kingdom. Tel: 44 207 224 1005; Fax: 44 207 224 1055; E-mail: email@example.com
In a mature medical specialty such as refractive surgery, the value of publishing the outcomes of a particular surgical technique, study, or case series is maximized if these outcomes are directly comparable to other publications. This can best be achieved by peer-reviewed journals adhering to a universal standard or format for reporting outcomes. Such standardization pervades scientific manuscript publishing: structured abstracts, four component text categories (introduction, methods, results, conclusions), reference formats, table layouts and headings, figure legends—all allowing a reader to more quickly assimilate an article.
In 2000, George O. Waring IIII MD, in association with the editorial staffs of the Journal of Refractive Surgery and the Journal of Cataract and Refractive Surgery, published an article titled “Standard Graphs for Reporting Refractive Surgery,”1 which set out a concise six-graph format for reporting clinical outcomes, covering the four main areas of accuracy, efficacy, safety, and stability. In 2006, Eydelman et al in the Astigmatism Project Group, American National Standards Institute (ANSI) Z80.11 Working Group on Laser Systems for Corneal Reshaping described a standard for reporting cylinder vector analysis,2 which is also an essential part of reporting refractive surgery outcomes.
The Standard Graphs for Reporting Refractive Surgery1 are instantly recognizable, help the reader quickly find some basic information for which he/she is looking for, and are easier to interpret visually than numerical details in the tables or text. Without this protocol, comparing outcomes among studies becomes more difficult and time consuming. Authors who choose to present graphic data in their own unique format, make it more challenging, impractical, less accurate, or even impossible to use their study for comparison with others.
Some examples of inferior quality reporting include:Accuracy of the refractive outcome is sometimes shown only as a cumulative percentage (eg, the number of eyes with a spherical equivalent refractive outcome within ±0.50 diopters [D]), whereas the results should indicate the percentage of over- and undercorrections as set out in the Standard Graphs for Reporting Refractive Surgery.1Some authors report visual acuity as a mean and standard deviation logMAR values; however, this method can hide outliers. Although a mean value can be of some use, it must be supplemented by the efficacy bar chart to show the cumulative percentage of eyes with uncorrected distance visual acuity (UDVA) at each Snellen line of vision as defined in the Standard Graphs for Reporting Refractive Surgery.1 Refractive surgeons are used to thinking about efficacy in terms of the percentage of eyes that can see 20/16 or better, 20/20 or better, etc. The efficacy bar chart reports UDVA results in a transparent manner and enables direct comparison among studies in which the Standard Graphs for Reporting Refractive Surgery have been used. Efficacy of UDVA outcomes is often reported incorrectly; many studies do not present the postoperative UDVA results in the context of preoperative corrected distance visual acuity (CDVA). For example, a series of phakic intraocular lens cases for extreme myopia might have a baseline CDVA of 20/20 or better in only 60% of eyes, which is necessary information to interpret the…