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1 William Harvey Hospital, Head and Neck Directorate, Kennington Road, Willesborough, Kent, TN24 0LZ, UK
2 Leeds General Hospital, UK
Correspondence to:
Frank C Schlichtenbrede
East Kent Hospitals, William Harvey Hospital, Head and Neck Directorate, Kennington Road, Willesborough, Kent, TN24 0LZ, UK; f.schlichtenbrede@ucl.ac.uk
Accepted for publication 6 July 2004
Keywords: visual experiences; cataract surgery
Cataract surgery is the most commonly performed elective surgery in many countries including the United Kingdom.1 With the majority of procedures performed under local anaesthesia, it is important for surgeons to recognise if patients are indeed visually aware of their environment. Understanding their experience would be a step forward in providing the safest and the most effective ophthalmic care to cataract patients.
Clinical significance of patients’ visual experience lies in the fact that a large number of patients are frightened by their experience, which potentially leads to a number of problems.2,3 This could range from poor cooperation during surgery to a sympathetic surge with undesirable adverse effects of hypertension, tachycardia, hyperventilation, and acute panic attack.
Since the visual disturbances during cataract surgery can cause fear and anxiety and adversely affect patient satisfaction, any measure that could reduce its negative impact would contribute to making the operation safer and more bearable.
Visual experiences during cataract surgery have not been discussed in any major ophthalmic textbooks and have not been well studied until recently.2–6
It is commonly expected by the majority of ophthalmologists that patients are not able to perceive much with the eye being operated on during surgery. Even the patient information leaflet published by the Royal College of Ophthalmologists, London, states, "you will not be able to see what is happening, but will be aware of a bright light."1 This advice, unfortunately, may not be accurate in a sizeable proportion of patients undergoing cataract surgery.7
A number of artists have expressed their experience during cataract surgery previously.5,8 Two of our patients also wrote back describing their visual experiences. Both underwent uneventful cataract surgery by phacoemulsification and intraocular lens implantation in our unit. One was a professional artist and the other a local poet. The artist sent us an elaborate drawing resembling a "colourful monkey" which portrayed his visual experience (fig 1). The poet sent us a poem, inspired by his visual perception (fig 2). His words clearly reflect the drawing. Taken together the drawing and the poem can in fact provide a tangible insight into how patients may visually experience cataract surgery under local aesthetic.
Figure 1 Artist’s impression of his visual experiences during cataract surgery.
Figure 2 Poem inspired by visual experiences during cataract surgery.
This documentation of visual experiences during cataract surgery could prove helpful to counsel patients on what to expect during the procedure. An explanation of possible visual experiences during local anaesthesia may relieve patient anxiety and should be included in patient information leaflets regarding cataract surgery. This could provide a useful tool to offer some reassurance to the anxious patients about to undergo the procedure. Patient counselling in this way may increase patient comfort and cooperation during the entire procedure.
References
Royal College of Ophthalmologists. Cataract surgery guidelines. London: Royal College of Ophthalmologists, 2001.
Au Eong KG, Lim TH, Lee HM, et al. Subjective visual experience during phacoemulsification and intraocular lens implantation using retrobulbar anesthesia. J Cataract Refract Surg 2000;26:842–6.
Au Eong KG, Low CH, Heng WJ, et al. Subjective visual experience during phacoemulsification and intraocular lens implantation under topical anesthesia. Ophthalmology 2000;107:248–50.
Au Eong KG, Lee HM, Lim ATH, et al. Subjective visual experience during extracapsular cataract extraction and intraocular lens implantation under retrobulbar anaesthesia. Eye 1999;13:325–8.
Murdoch IE, Sze P. Visual experience during cataract surgery. Eye 1994;8:666–7.
Newman DK. Visual experience during phacoemulsification cataract surgery under topical anaesthesia. Br J Ophthalmol 2000;84:13–15.
Au Eong KG. The Royal College of Ophthalmologists cataract surgery guidelines: what can patients see with their operated eye during cataract surgery? Eye 2002;16:109–10.
Sumich PM, Francis IC, Kappagoda MB, et al. Artist’s impression of endocapsular phacoemulsification surgery. J Cataract Refract Surg 1998;24:1525–8.