Effect of preoperative counseling on fear from visual sensations during phacoemulsification under topical anesthesia

To determine whether preoperative counseling on possible intraoperative visual perceptions during cataract surgery helps reduce the patients' fear during surgery.

Aravind Eye Hospital, Madurai, India.

Randomized masked clinical trial.

Patients having phacoemulsification under topical anesthesia were randomized to receive additional preoperative counseling or no additional preoperative counseling on potential intraoperative visual perceptions. After surgery, all patients were interviewed about their intraoperative experiences.

Of 851 patients, 558 (65.6%) received additional preoperative counseling and 293 (34.4%) received no additional counseling. A lower proportion of patients in the counseled group were frightened than in the group not counseled for visual sensation (4.5% versus 10.6%, P<.001). Analyzed separately by specific visual sensations, similar results were found for light perception (7/558 [1.3%] versus 13/293 [4.4%], P=.007), colors (P=.001), and movement (P=.020). The mean fear score was significantly lower in the counseled group than in the not-counseled group for light perception (0.03 versus 0.12, P=.002), colors (P=.001), movement (P=.005), and flashes (P=.035). Preoperative counseling was a significant factor affecting fear after accounting for age, sex, operated eye, and duration of surgery (multivariate odds ratio, 4.3; 95% confidence interval, 1.6-11.6; P=.003).

Preoperative counseling on possible visual sensations during cataract surgery under topical anesthesia significantly reduced the mean fear score and the proportion of patients reporting being frightened.