The impact of surgery on self-reported metamorphopsia and vision-related quality of life in patients with an idiopathic full-thickness macular hole

Background:Metamorphopsia (distorted vision) is among the most common symptoms reported by patients with idiopathic full thickness macular hole (iFTMH) and is related to significant deterioration in Vision-Related Quality-of-Life (VRQoL). Surgical closure with pars plana vitrectomy (PPV) is the chief determinant of visual acuity postoperatively, but the extent of visual improvement is variable. The aim of this study was to assess the impact of surgery on the self-reported prevalence and severity of metamorphopsia and the VRQoL in patients with an iFTMH. Methods: Prospective consecutive case series study. The Metamorphopsia Questionnaire (MeMoQ) and the National Eye Institute Visual Functioning Questionnaire - 39 (VFQ-39; assesses the VRQoL) were completed by patients before and three months post-PPV for iFTMH. The pre- and post-operative presence and severity of metamorphopsia was highlighted through a severity scale with a maximum of 9 points for the 9 questions in the MeMoQ. Responses for the VFQ-39 were categorised into subscales as per the VFQ-39 guidance. Wilcoxon signed rank test was performed for each subscale to identify subscales with a statistically significant improvement post-PPV. Results: 30 patients: 9 male, 21 female. Age range 47-82 y/o. Operated between August 2019 - December 2020 at St Paul’s Eye Unit, Liverpool. There was a statistically significant improvement of metamorphopsia (P<0.05) following surgery, with a mean reduction in severity of 2.18 points. In the VFQ-25, a statistically significant improvement (P<0.05) was seen in the following subscales; general vision, near activities, distance activities, social functioning, mental health, role difficulties, dependency, driving and peripheral vision.  Discussion: This study highlights the significant improvement of metamorphopsia associated with an improvement in vision in patient who underwent vitrectomy for FTMH. The significant improvement in the mental health is particularly interesting in this COVID era where patients are susceptible to an increased risk of mental health deterioration. 