Exploring patient involvement in target refraction decision-making for cataract surgery

Post-surgical emmetropia is frequently used as the target refraction in cataract surgery. Such target does not reflect guidance available from regulatory or professional bodies which recommend that the refractive implications of surgery, notably changes in post-surgical spectacle needs, should be discussed with the patient. This study aimed to explore patient perspectives on their involvement in and preferences for target refraction decision-making during routine cataract surgery.

In-depth semi-structured interviews were conducted with participants with a history of cataract surgery in both eyes with the UK National Health Service between 2018 and 2023. Interviews were conducted in person or by telephone and audio-recorded. Data were transcribed and analyzed using reflexive thematic analysis. Pre- and post-surgical refractive data were obtained to complement thematic analysis.

Thematic saturation was reached after 10 participants completed the in-depth interviews (median [IQR] age 72 (10) years; 70% female). Two main and five sub-themes were developed. The first main theme (1) 'Understanding target refraction' revealed considerable participant uncertainty and limited understanding of the concept 'target refraction'. Participants reported varied experiences in their clinician-patient discussions regarding target refraction, highlighting a notable degree of heterogeneity. The second theme (2) 'Factors affecting choice of target refraction' highlighted that pre-surgical spectacle wear habits are key determinants of patients' post-surgical spectacle wearing preferences, which are broadly independent of target refraction. Overall, patients were satisfied with vision restoration and hesitant to participate in target refraction decision-making due to misconceptions. A trusting clinician-patient relationship was widely reported.

This study provides evidence for patients' limited awareness of the potential to personalize target refraction to individual spectacle wear preferences, which may influence their willingness to be involved in target refraction decision-making. Further research is warranted to quantify the frequency of these perspectives across a broader population as well as explore current target refraction educational strategies.