Preoperative Management of Cataract Surgery Candidates: An Evaluation of Their Perception and Preferences

doi:10.4236/ojoph.2013.33021

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Open Journal of Ophthalmology, 2013, 3, 90-92

http://dx.doi.org/10.4236/ojoph.2013.33021 Published Online August 2013 (http://www.scirp.org/journal/ojoph)

Preoperative Management of Cataract Surgery

Candidates: An Evaluation of Their Perception and

Preferences

Evgenia Kanonidou*, Vasileios Konidaris, Christina Kanonidou, Leonidas Papazisis

Department of Ophthalmology, General Hospital of Veria, Veria, Greece.

Email: *[email protected]

Received January 4th, 2013; revised February 5th, 2013; accepted March 4th, 2013

cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Purpose: To assess the primary visual disabilit y in patients with cataract and to ev aluate their preference regarding the

visual outcome after surgery. Materials and Methods: 120 patients (66 males, mean age 76.3 years, mean best cor-

rected visual acuity 5.2/10 binocularly) participated. Perception regarding the primary visual disability related to cata-

ract and preference of visual outcome after surgery were assessed by a questionnaire. All study procedures adhered to

the principles outlined in the Declaration of Helsinki for research involving human subjects, and all participants gave

written informed consent before their participation. Results: 74 patients (61.6%) had difficulty in distant vision, 5

(4.2%) in near vision, 17 (14.2%) mentioned blurred vision, 14 (11.7%) difficulty in driving especially at night, 7 (5.8%)

complained about monocular diplopia and 3 (2.5%) about anisometropia. All mentioned that they preferred to obtain

clear distant and near vision after cataract surgery. Conclusions: There was an interesting variety in visual disability

related to cataract. The difficulty in distant vision was the primary visual deficit in the majority of the patients and the

preference for clea r distant and near vision was the desired postoperative visual outcome.

Keywords: Cataract; Visual Outcome; Visual Disability; Quality of Life

1. Introduction ability in patients with cataract, their perception regard-

ing the postoperative visual outcome and their prefer-

ences regarding the preoperative management.

Cataract is one of the commonest causes of vision loss

and the commonest cause of reversible loss of useful

vision worldwide [1]. It is defined as the loss of trans-

parency of the natural lens of the eye, usually due to the

ageing process [1,2]. The only treatment is surgery,

which has become the most frequent performed surgery

in industrialized countries [2]. As the trend towards

smaller incisions and shorter operating time continues,

less sedation and anesthesia are required [3]. Topical

anesthesia and intracameral anesthesia are the standard for

cooperative patients [4-6]. Snellen chart visual acuity is

the standard procedure to measure the preoperative visual

acuity and thereby the indication of cataract surgery and

the postoperative outcome. However, the disability of a

patient with cataract goes beyond the loss of visual acuity,

as decreased visual function is associated with poor qual-

ity of life and general functioning living activities. The

aim of this study was to evaluate the primary visual dis-

2. Methods

120 patients (66 males) with mean age 76.3 years old and

mean best corrected visual acuity 5.2/10 binocularly par-

ticipated in the study. All the patients were recruited

through the cataract clinic of the Department of Oph-

thalmology of General Hospital of Veria, Veria, Greece

for a time period of one year. All had a history of visu-

ally significant cataract for their daily activities for at

least six months and suffered from no other ocular co-

morbidity. All the participants were of a basic educa-

tional level and occupied themselves with agriculture.

Their perception regarding the primary visual disability

related to cataract, their preference with respect to the

visual outcome after cataract surgery as well as their at-

titudes related to the preoperative management was as-

sessed by means of a simple questionnaire. All study

*Corresponding a uthor.

Preoperative Management of Cataract Surgery Candidates: An Evaluation of Their Perception and Preferences 91

procedures adhered to the princip les outlined in the Dec-

laration of Helsinki for research involving human sub-

jects, and all participants gave written informed consent

before their participatio n.

3. Results

74 patients (61.6%) had difficulty in distant vision, 5

(4.2%) in near vision, 17 (14.2%) mentioned blurred vi-

sion as the primary visual disability associated with

cataract while 14 patients (11.7%) had difficulty driving

especially at night. Moreover, 7 patients (5.8%) com-

plained about monocular diplopia while 3 (2.5%) about

anisometropia (Figure 1). All the participants mentioned

that despite their preoperative refractive status preferred

to obtain clear vision for both distant and near after cata-

ract surgery. All the patients wanted the preoperative

general screening tests to be undertaken in the hospital

compared to private practice. 78 (65%) preferred to re-

turn home the day of the surgery while 42 (35%) would

felt more secure with a day residency in the hospital. 99

(82.5%) wanted the anesthesia to be provided by eye

drops instillation while 21 (17.5%) with injection. 78

(65%) preferred the surgery to be performed by a male

surgeon, 6 (5%) by female, while the rest (30%) did not

show any particular preference. 12 (10%) patients pre-

ferred to be transferred to the theatre with a patient bed,

40 (33%) with a wheel-chair, while the rest (57%) on

foot. The desired refractive outcome after cataract sur-

gery was clear vision for both distance and near in all

patients. All preferred to be examined every week after

the surgery and for a month’s period of time. All were

absolutely satisfied by their preoperative management

and the only reason for disappointment was the crowded

wards.

4. Discussion

Our study provides important documentation about the

primary visual disability in patients with cataract and

their preference regarding the visual outcome after cata-

Figure 1. Primary visual disability in patients with cataract

who participated in our investigation.

ract surgery. It was interesting to observe the variety in

visual disability related to cataract, with difficulty in dis-

tant vision being the primary visual deficit in the major-

ity of the patients, as well as their preference for clear

vision for both distant and near as the desired postopera-

tive visual outcome. Recent studies suggest that poor

vision has a greater impact on patients’ lives than was

previously thought, comparable with major medical con-

ditions such as stroke [7]. Moreover, the benefits of

cataract surgery on visual function have been demon-

strated in several investigations [8-10], suggesting that

cataract surgery improves functioning in everyday life

with respect to vision dependent activities.

Understanding the spectrum of disability associated

with visual impairment from cataracts can help clinicians

improve their approach to treat ment and rehabilitation o f

these patients. Additionally, in our study, it was interest-

ing to note that there was reluctance in the majority of

the patients for the surgery to be performed by a female

surgeon. This is pr obably related to elderly patients’ cau-

tiousness regarding female surgical skills in the rural area

of Greek territory.

5. Conclusion

In conclusion, in this article, perception of 120 patients

regarding the primary visual disability related to cataract

and preference of visual outcome after surgery were as-

sessed by a questionnaire to assess the primary visual

disability in patients with cataract and to evaluate their

preference regarding the visual outcome after surgery. As

patients have widely differing visual demands, it is vital

to take these into account when considering surgery in

order that surgery induced improvements in visual acuity

be translated by considerable gains in real life activities,

emotional and social life co mponents.

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