Our study is the first from a developing country to examine the knowledge of doctors regarding the visual sensations and their associated anxiety/fear that patients can experience during cataract surgery. In our study, the surveyed eye doctors reported that, in their opinion, 38.9% and 64.3% patients could see during cataract surgery under regional and topical anaesthesia, respectively. This is a significant underestimation of the proportion of patients who may actually experience visual sensations. Previous studies
[3–6, 9–14] indicate that 89% to 100% patients operated under topical anaesthesia and 55.7% to 87.5% patients operated under regional anaesthesia retain at least sufficient vision to perceive light.
24.2% to 36.9% patients, the doctors estimated, would experience anxiety/fear due to visual sensations. These percentages are higher than those reported in previous studies
[4, 5, 7, 9–11] which showed that such visual sensations are a cause of fear/anxiety in 3% to 19% of the patients.
Patients’ cooperation is essential in all stages of cataract surgery. However, it can be lost due to fear and anxiety, increasing the risk of perioperative complications. Fear and/or anxiety may also result in other adverse events such as increased heart rate and blood pressure, difficulty in breathing, and an acute panic attack. All these events are undesirable considering that many people undergoing cataract surgery are elderly having multiple co-morbidities such as hypertension or ischaemic heart disease
. Fear and anxiety due to visual sensations can be prevented by effective pre-operative counselling of patients
[11, 15]. For example, in a randomized clinical trial
, Haripriya and colleagues found that patients receiving counselling were significantly less likely to have fears from visual sensations during cataract surgery under topical anaesthesia compared with their counterparts who did not receive such counselling.
However, it was disappointing to note that less than half of the eye doctors in our study regularly counselled their patients preoperatively (32.4% and 45.6% for regional and topical anaesthesia, respectively) which shows that not much attention is being paid to this detail. Although it was encouraging to note that most surgeons had a good knowledge of the different visual sensations patients can experiences during cataract surgery, some participants expressed amazement when they read the questionnaire and even remarked that they had never thought about it (the visual phenomenon).
A limitation of this study was that a significant number of respondents left some questions concerning visual sensations unanswered. Those who did not answer were more likely to be consultants and men. A possible explanation is that the study was conducted during an eye conference when many of the participants were unable to devote sufficient attention and time to complete the survey form. The relatively large number of questions examined could have been overwhelming for some of the participant eye doctors and may have contributed to the missing data.