Subjective visual experience during cataract surgery:A survey of patients and ophthalmologists / 中华实验眼科杂志

ABSTRACT

Background Patients' experience during phacoemulsification cataract surgery is an important determinant of patient's satisfaction with surgery effectiveness.Local anaesthesia could be associated with different intraoperative visual awareness because of retention of optic nerve function.Relieving the anxiety of patients arose from intraoperative visual awareness is of important clinical significance.Objective This study was to discuss the necessity of preoperative conversation and psychological counseling and to improve the quality of surgery and the satisfaction of patients.Methods One hundred and fifty-three patients who had undergone sequential phacoemulsification and intraocular lens (IOL) implantation in the same operation under local anaesthesia from October,2010 to December,2010 in Tangdu Hospital and Xi'an First People's Hospital,received a standardized questionnaire designed based on similar questionnaires from abroad and surveyed regarding their intraoperative visual experience,including light perception,their detection of color,photopsia,and their detection of the movement of the surgeon,instrument,and changes in light intensity during cataract surgery.In another survey,seventy ophthalmologists in the Xi'an area with ≥ 10 years (33) and ＜ 10 years of experience (37) participated in a questionnaire about their recognition and response to these visual experiences,designed based on the 2010 Chinese Doctors General Questionnaire.Results During the phacoemulsification and IOL implantation,27 patients (17.6％) lost light perception,98 patients (64.1％) had light perception,28 patients (18.3％) detected more than one color,25 patients (16.3％) had photopsia,49 patients (45.1％) sensed the movement of the surgeon,26 patients (17.0％) was able to see surgical instruments,11 patients (7.2％) saw the surgeon's fingers,4 patients (2.6％) saw the surgeons,65 patients (42.5％) detected changes in light intensity and 12 patients (7.8％) saw the IOL loop and others.21.4％ of the 70ophthalmologists believed these patients might have lost light perception;while 78.3％ thought these patients retained light perception.Under local anaesthesia,93.9％ of the more experienced surgeons and 75.6％ of the junior surgeons deemed that good preoperative counseling was helpful for the patients,but only 45.5％ of the more experienced surgeons and 24.3％ of the junior surgeons counseled patients regarding intraoperative visual experience.Conclusions Most patients will experience a variety of visual sensations during phacoemulsification and IOL implantation under local anaesthesia.Many ophthalmologists are aware of these conditions.Most of the ophthalmologists believe that patients suffer from fear from these intraoperative visual experiences and claim that preoperative counseling to patients can relieve that fear,but less of them communicate these possible experiences to patients.This study offers some discussions about preoperative counseling.