Experiences following cataract surgery – patient perspectives

Abstract

Purpose Most patients report being highly satisfied with the outcome of cataract surgery but there are variable reports regarding the impact of cataract surgery on some real‐world activities, such as fall rates. We hypothesised that adaptations to changed refractive correction and visual function may cause difficulties in undertaking everyday activities for some patients and used a series of focus groups to explore this issue. Method Qualitative methods were used to explore patients’ experiences of their vision following cataract surgery, including adaptation to vision changes and their post‐surgical spectacle prescription. Twenty‐six participants took part in five focus groups (Mean age = 68.2 ± 11.4 years), and the data were analysed using thematic analysis. Results We identified three themes. ‘Changes to Vision’ explores participants’ adaptation following cataract surgery. While several had problems with tasks relying on binocular vision, few found them bothersome and they resolved following second eye surgery. Participants described a trial and error approach to solving these problems rather than applying solutions suggested by their eyecare professionals. ‘Prescription Restrictions’ describes the long‐term vision problems that pre‐surgery myopic patients experienced as a consequence of becoming emmetropic following surgery and thus needing spectacles for reading and other close work activities, which they did not need before surgery. Very few reported that they had the information or time to make a decision regarding their post‐operative correction. ‘Information Needs’ describes participant’s responses to the post‐surgical information they were given, and the unmet information need regarding when they can drive following surgery. Conclusion The findings highlight the need for clinicians to provide information on adaptation effects, assist patients to select the refractive outcome that best suits their lifestyle, and provide clear advice about when patients can start driving again. Patients need to be provided with better guidance from clinicians and prescribing guidelines for clinicians would be beneficial, particularly for the period between first‐ and second‐eye surgery.

Investigating target refraction advice provided to cataract surgery patients by UK optometrists and ophthalmologists

“…20 Despite this, a recent focus group study (n = 26) found 27% of patients had discussion regarding their target refraction or were not given sufficient time or information to make an informed choice, and therefore deferred to the ophthalmologist's recommendation. 11 This study aimed to investigate if clinicians did discuss target refraction with their patients. We found both optometrists and ophthalmologists had differing views of when target refraction should first be discussed with the patient.…”

“…Target refraction discussions are vital to ensure patient satisfaction post‐operatively. Current advice from the NHS states, “Providers must ensure that patients have sufficient time to consider these complex issues, and decisions such as post‐operative target refraction should be determined and agreed with the patient well in advance of the scheduled surgery date.” 20 Despite this, a recent focus group study ( n = 26) found 27% of patients had no discussion regarding their target refraction or were not given sufficient time or information to make an informed choice, and therefore deferred to the ophthalmologist's recommendation 11 …”

“…The power of the IOL involves accurate keratometry, biometry and anterior chamber depth measurements, plus the selection of an appropriate IOL power formula 9,10 . Obtaining the correct target refraction is needed to ensure visual needs are met and the patient is happy with the outcome of surgery 11 …”

“…A focus group study exploring patients’ experiences of their vision following cataract surgery found a lack of knowledge among patients of how their final prescription would impact the type of spectacles worn post‐surgery 11 12,13 showed that some patients who were myopic pre‐surgery and preferred to read without spectacles struggled with their post‐surgical emmetropia, and would have preferred a myopic target refraction to allow them to continue to read without spectacles post‐surgery 12,13 .…”

“… 9 , 10 Obtaining the correct target refraction is needed to ensure visual needs are met and the patient is happy with the outcome of surgery. 11 Patients in the UK currently receiving surgery under the publicly funded National Health Service (NHS) are only eligible for monofocal IOLs, and so will require distance or near vision spectacles for complete visual restoration following surgery. Despite this, it has been demonstrated that a main motivation to undergo surgery is to achieve spectacle independence.…”