Brow ptosis: are we measuring the right thing? The impact of surgery and the correlation of objective and subjective measures with postoperative improvement in quality-of-life.

Introduction: To assess the effect of brow ptosis on visual function and quality-of-life (QoL), and to determine what measures are associated with post-surgical change in functional status.

Methods: Prospective longitudinal study. Fifteen consecutive patients undergoing brow-lift surgery from February 2009 to August 2010.

Main Outcome Measures: pre- and post-operative eyelid position (ie, distance mm from corneal reflex to upper skin fold (FRD1), lowest brow hair to lower limbus (LLB), centre of lower lid to upper lid skin fold (LLF)) and number of points missing in 'superior' and 'superior plus elsewhere' Humphrey 120-point visual field, as well as a Quality-of-life and Visual Function questionnaire before and after brow lift surgery.

Results: The strongest correlation between pre-op functional index score and any pre-op objective measure was visual fields (r=-0.46, P<0.085). There was a mean 36-point increase in functional index score after brow lift surgery (P<0.001).Self-reported preoperative functional impairment was the only outcome measure significantly (and strongly) associated with post-surgical improvement in functional status (r=-0.833, P<0.001).

Conclusions: Surgical repair of brow ptosis results in a measurable increase in health-related QoL. The preoperative QoL score is the best predictor of postoperative improvement in QoL. The best available objective preoperative parameter for indicating postoperative QoL improvement is visual fields. These two measures should be used to better predict successful surgical outcomes.