Fear of vision loss and blindness can prevent some cataract patients from choosing to undergo the operation, according to new University of Cincinnati (UC) research.
A qualitative study in The Journal of Clinical Ophthalmology used the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) to assess the health literacy and cataract surgery perceptions of a 42-person cohort based at Hoxworth Eye Clinic.
“The blanket theme in our research study was building trust, encouraging patient-centered decision making, and identifying the etiologies of fear, which are deeply complex and highly individualized,” explains Stephanie Wey, study author and an ophthalmologist at Scheie Eye Institute, University of Pennsylvania.
Of the 42 patients surveyed – all diagnosed with cataract by ICD-10 and/or a physical exam, and with no history of prior cataract surgery – 36 percent reported having a fear of cataract surgery, with over half of these patients (53 percent) noting that fear of vision loss was a contributing factor.
Contrary to their initial hypothesis, the researchers found that there was no significant association between lower health literacy and an increased fear of surgery. Instead, it was the quality of a patient’s vision that influenced how fearful they were: cataract patients with better vision (BCVA worse than 20/40 in neither eye) were more anxious than those with already limited vision (BCVA worse than 20/40 in both eyes or one eye). Thus, patients with already poor vision perceive the potential benefits of vision improvement outweigh the documented risks of cataract surgery, the authors suggest.
“Our study found that fear was an issue, but not why fear was an issue,” says study author Lisa Kelly, Endowed Professor-Educator and Director of Medical Student Education in Ophthalmology at UC’s College of Medicine. “We speculate that for each patient, the etiology behind that fear may be mixed and highly personalized, with a fear of undergoing surgery being tied to the perceived risk surrounding potentially worsening vision.”
“While our findings parallel other studies that show a lack of an association between health literacy and fear of cataract surgery,” adds Samantha Hu, corresponding study author and a medical graduate at UC, “we cannot speak definitively to the generalizability beyond our patient population in urban academic hospital-based clinic settings.”
The authors recommend that clinicians prioritize clarifying the goals of surgery and addressing any fears directly, particularly in the early stages of patients displaying “non-visually significant cataracts.”
Wey concludes: “It is critical that clinicians are conscientious that fears of vision loss and cataract surgery may be widespread, regardless of the individual patient risks, so taking the time to walk through the procedure and its potential benefits and risks remains important for every patient.”
