The Only Eye Study (OnES): a qualitative study of surgeon experiences of only eye surgery and recommendations for patient safety

Abstract

ObjectivePerforming surgery on patients with only one seeing-eye, where complications may result in catastrophic vision loss, presents unique challenges for the ophthalmic care team. There is currently no evidence regarding how surgeons augment their care when treating only eye patients and no guidelines for how these patients should be managed in hospital eye services. This study aimed to explore ophthalmic surgeons’ experiences of only eye surgery and perceptions of current practice.Design and participantsTen ophthalmic surgeons were asked to relate their experiences and views on performing only eye surgery in indepth, semistructured interviews. Interviews were audio-recorded and transcribed. Qualitative data were subjected to thematic analysis to identify key themes.SettingHospital eye service.ResultsFive key themes emerged relating to surgeons’ experiences and perceptions of only eye surgery: (1) differences in approach to consent, (2) strategies for risk reduction, (3) unmet training needs, (4) value of surgical mentor and (5) emotional impact of unsuccessful outcomes. Recommendations for improving the surgical journey for both the patient and the surgeon related primarily to better recognition and understanding of the complexities inherent with only eye surgery.ConclusionsOutcomes of only eye surgery may be improved through a number of methods, including development of purpose-designed training fellowships, adoption of stress-reducing strategies and enhancement of available support services. The findings identify emerging themes unique to only eye surgery and the need for guidelines on the provision of care for these high-stakes surgical patients.

Glaucoma Home Monitoring Using a Tablet-Based Visual Field Test (Eyecatcher): An Assessment of Accuracy and Adherence Over 6 Months

“…Multiple studies have shown that intensive VF monitoring could help to identify and prioritize individuals most at risk of debilitating sight loss 11 , 12 , 13 , 14 , 15 (i.e., younger patients with fast-progressing VF loss 16 ). Frequent (e.g., monthly) monitoring is likely to be of particular benefit for those patients for whom rapid progression is most likely (e.g., optic disk hemorrhage 17 , 18 , 19 ) or most costly (e.g., monocular vision 20 ).…”

Only eye study 2 (OnES 2): ‘Am I going to be able to see when the patch comes off?’ A qualitative study of patient experiences of undergoing high-stakes only eye surgery

“…The first research output (OnES 1) identified recommendations on how to optimise patient safety from surgeons' perspectives, and the role of purpose-designed training fellowships and Open access stress-reducing strategies in high-stakes procedures. 12 In this study, we make recommendations for surgical care explored through the patient perspective. Based on our interview findings, we developed a model for optimal patient-centred care in only eye surgery (see online supplemental appendix 1).…”

“…Individuals who met our criteria for being an only eye patient were invited to participate in a semistructured interview. As described in our previous work, 12 the definition of an only eye was where significant loss of vision in this eye would be deemed life changing with profound impact on a patient’s quality of life. VA in the fellow eye of <3/60 or worse ± end-stage visual field loss was considered insufficient to maintain the patient’s current independent lifestyle.…”

“…The outcomes of surgeon interviews have been described in a previous report. 12 Patients were included in the study advisory group who helped to develop the interview topic guide. Following data analysis, a 'Bridging the Gap' event Open access was hosted at Queen Elizabeth Hospital Birmingham to disseminate the research findings and conduct a membercheck exercise among stakeholders including surgeons, patients and carers.…”

“…Evidence suggests surgeons performing only eye surgery experience high levels of stress, as well as intense feelings of accountability when things go wrong. 12 Currently, there is limited evidence relating to patient experiences of only eye surgery. A comprehensive evidence-based understanding of these high-stake procedures would help spotlight areas for improvement and promote a better surgical experience for patients.…”