Visual experience during phacoemulsification under topical versus retrobulbar anesthesia: Results of a prospective, randomized, controlled trial

Patients' expectation and experience of visual sensations during phacoemulsification under topical anaesthesia

“…This finding is similar to a recent randomised controlled trial conducted in India, which found that visual experiences can be both pleasant and unpleasant. 19 Our anecdoctal experience has also shown that some patients do find their visual experiences pleasant owing to the unexpected multitude of colours and shapes, an observation that has been pointed out in recent articles by Zia et al 20 and Au Eong et al 21 Newman documented that six out of 102 patients (5.9%) lost light perception at times during phacoemulsification and IOL implantation under topical anaesthesia. 13 Transiently raised intraocular pressure could be responsible for this phenomenon.…”

“…It has been shown in a recent prospective randomised clinical trial that more patients operated on using topical anaesthesia experienced perception of light, colours, and a change in light brightness compared to those operated on using retrobulbar anaesthesia. 19 The results therefore suggest that preoperative counselling should target all patients regardless of their preoperative expectations or whether or not they have had a previous cataract surgery.…”

Reply to Dr Tan

“…We agree that there is a variation in the number of patients who are frightened by intra-operative VPs, but overall the percentage of such patients is small. It is appropriate to state that the majority of patients find VPs during intra-ocular surgery bearable; some find them even pleasant [2][3][4] and one has found them good enough to write a poem about them. 5 In our study, 52/72 (72.22%) of patients described their VPs as 'bearable', and only two patients (2.7%) thought that they were 'frightening'.…”

Visual perceptions induced by intravitreous injections of therapeutic agents

“…3 Indeed, some authors are even using IVT therapeutic agents for relatively rare disorders, such as central serous chorioretinopathy. 3 Patients' visual perceptions and experiences induced by frequently performed ophthalmic surgical procedures, such as cataract surgery (under topical [10][11][12][13][14][15] and regional anesthesia [11][12][13][14]16,17 ), glaucoma filtration surgery, 18 and vitreoretinal surgery, [19][20][21][22] are well documented. Indeed, the beneficial effect of preoperative counseling with respect to known and anticipated visual experiences during phacoemulsification cataract surgery, under topical anesthesia, in terms of reducing patients' fear, has been described.…”