A comparison of patient pain and visual outcome using topical anesthesia versus regional anesthesia during cataract surgery

Evaluating the accuracy of a cataract surgery simulation video in depicting patient experiences under conscious anesthesia

PURPOSE

To evaluate the accuracy of a point-of-view cataract surgery simulation video in representing different subjective experiences of patients undergoing the procedure.

METHODS

One hundred consecutive post-cataract-surgery patients were shown a short simulation video of the surgery obtained through a porcine eye model during the first postoperative week. Patients then answered a multiple-choice questionnaire regarding their visual and tactile intraoperative experiences and how those experiences matched the simulation.

RESULTS

Of the patients surveyed (n = 100), 78% (n = 78) recalled visual experiences during surgery, 11% recalled pain (n = 11), and 6.4% (n = 5) recalled frightening experiences. Thirty-six percent of patients (n = 36) were interviewed after their second cataract surgery; there was no statistically significant difference between anxiety scores reported before the first eye surgery and second eye surgery (p = 0.147). Among all patients who recalled visual experiences (n = 78), nearly half (47.4%) reported that the video was the same/similar to their experience. Forty-eight percent of the patients recommended future patients to watch the video before their procedures, and more than a third (36%) agreed that watching the video before surgery would have helped them to relax.

CONCLUSIONS

Our model reflects the wide range of subjective patient experiences during and after surgery. The high percentage of patients who found the video accurate in different ways suggests that, with more development, point-of-view cataract simulation videos could prove useful for educational or clinical use. Further research may be done to confirm the simulation's utility, by screening the video for subjects before operations.

Validation of a novel patient satisfaction questionnaire for preoperative fasting in cataract surgery: a discrimination analysis

OBJECTIVE

Preoperative fasting is routinely performed to prevent anaesthesia-related pulmonary aspiration. To capture patients' experiences with preoperative fasting, a 13-item questionnaire was developed and validated using Rasch analysis and shortened to 6 items. This extension study aims to assess this questionnaire's ability to discriminate between participants with a short versus long duration of fasting and early versus late day surgery.

DESIGN

Single-centred cross-sectional study.

PARTICIPANTS

Subjects were recruited via consecutive sampling of cataract patients on surgery day at Kensington Eye Institute in Toronto from February to December 2019.

METHODS

A validated preoperative fasting questionnaire was administered. Discriminative ability was assessed by comparing responses in patients scheduled for surgery in the morning (8:00 am-12:00 pm) versus afternoon (12:00 pm-3:30 pm) and fasting for short (≤8 hours) versus long (>8 hours) duration. Diagnostic ability of the 6-item questionnaire relative to the 13-item questionnaire was assessed with receiver operating characteristics curve analysis.

RESULTS

A total of 164 patients (mean age 70.8 ± 10.0 years; 57% female) were included. Total scores of patients having surgery in the morning were greater (i.e., less fasting-related burden) than in the afternoon (p = 0.04). There was no significant difference in scores between patients fasting for a short versus long duration (p > 0.05). Receiver operating characteristics curve analysis showed excellent diagnostic ability of the 6-item questionnaire relative to the 13-item version (area under the curve = 0.964).

CONCLUSION

The 6-item questionnaire for fasting-related burden has excellent discriminative ability between early versus late surgery patients. The time fasting while awake may be a more relevant predictor of fasting-related burden relative to the total duration of fasting.

Development and Validation of a Questionnaire Assessing Patient Distress from Preoperative Fasting in Cataract Surgery

Purpose: To develop and psychometrically validate a questionnaire to measure patient distress with preoperative fasting related to cataract surgery.Methods: In this single-centered cross-sectional study, consecutive sampling of cataract patients was undertaken immediately preoperatively from February to December 2019. A questionnaire evaluating patient distress with fasting was designed and administered. Questionnaire development occurred in an iterative process and was conducted with consultation from expert investigators and patients. Validation and psychometric evaluation of the questionnaire were performed with Rasch analysis.Results: A preliminary version of the questionnaire was developed by 10 study investigators. Across five iterations of development, the questionnaire was administered to 186 cataract patients. Psychometric evaluation of the 13-item questionnaire demonstrated ordered thresholds, acceptable item calibration and fit, adequate internal consistency, ability to discriminate between three levels of distress from preoperative fasting and no notable differential item functioning. However, issues with mistargeting, clustering of items on the person-item map and multidimensionality remained. Given these concerns, 13 separate re-analyses were conducted via removal of certain items. A 6-item subset was determined to be well targeted, unidimensional, did not display item clustering and was able to discriminate between patients with high and low distress from preoperative fasting.Conclusion: A 6-item questionnaire is a valid, psychometrically robust and reliable measure for the assessment of patient distress with preoperative fasting in cataract surgery. Items include hunger, thirst, hoarseness, weakness, anxiety and nausea. Future studies should seek to validate this questionnaire across a variety of sociodemographic contexts, languages and specialties.

Hypnosis intervention for the management of pain perception during cataract surgery

Objective

To investigate the effectiveness of hypnosis in pain management during cataract surgery.

Methods

Male or female patients with bilateral age-related cataract who wished to have both eyes subjected to phacoemulsification surgery were preliminarily admitted. Immediately after the first-eye surgery, each patient was evaluated for pain using the visual analog scale (VAS), and patients with a VAS score >1 were enrolled. By using block randomization, the enrolled patients were allocated to either the treatment group, which received a hypnosis intervention before the scheduled second-eye surgery, or the control group, which did not undergo hypnosis. The levels of anxiety, pain, and cooperation were evaluated independently by the patients and the surgeon.

Results

During the intraoperative pain assessment, 5%, 34%, 38%, and 23% of patients in the control group reported experiencing no pain, mild pain, moderate pain, and severe pain, respectively. In contrast, in the hypnosis group, 18%, 56%, 15%, and 11% of patients reported experiencing no pain, mild pain, moderate pain, and severe pain, respectively, which showed significant differences between the groups (P<0.005). The evaluation of anxiety level showed that the mean score in the control group and hypnosis group was 11.77±0.32 and 6.64±0.21, respectively, revealing a highly significant difference between the two groups (P<0.005). The assessment of patient cooperation showed that only 5% and 18% of patients in the control group and 18% and 36% of patients in the hypnosis group showed excellent and good cooperation, respectively, while 47% of patients in the control group and only 24% of patients in the hypnosis group exhibited poor cooperation, revealing significant differences between the groups (P<0.005).

Conclusion

Hypnosis may be considered as an auxiliary measure in cataract surgery, especially for patients who experienced obvious pain during the first-eye surgery.