Justin Cooper , 2025-05-15 19:25:00
Key takeaways:
- Patients with BCVA worse than 20/40 in both eyes reported no fear of surgery vs. 40% of those with BCVA worse than 20/40 in one eye.
- Fear had no link to health literacy or cataract knowledge.
Fear of cataract surgery is greater among patients with better vision and is not influenced by knowledge of cataracts or overall health literacy, according to a study published in Clinical Ophthalmology.
The study was inspired by the attitudes of patients with cataracts treated at Hoxworth Eye Clinic at the University of Cincinnati Medical Center.
“Patients often seemed surprised when their cataracts had become visually significant and cataract surgery was brought up as an option. Patients often did not want to pursue cataract surgery, even though their cataracts looked like they would be visually bothersome,” study co-authors Samantha Hu and Stephanie Wey, MD, both of the University of Cincinnati College of Medicine, told Healio. “It was possible we did not understand what our patients knew about cataracts and cataract surgery and that this may or may not be tied to health literacy.”
Hu and colleagues surveyed 42 patients at Hoxworth Eye Clinic who were 50 years or older and diagnosed with cataracts.
Patients completed two surveys. One survey gauged their understanding of cataracts and their attitudes toward surgery and vision loss. The other assessed their overall health literacy using a seven-item word recognition test.
Overall, 80% of patients scored perfectly on the health literacy assessment. About 36% reported fear of cataract surgery, 53% of whom cited fear of vision loss as a reason.
The analysis found that fear of cataract surgery had no statistically significant relationships with patients’ health literacy score or their specific knowledge of cataracts.
Lisa D. Kelly
“Our study found that fear was an issue but not why fear was an issue,” study co-author Lisa D. Kelly, MD, director of medical student education in ophthalmology at the University of Cincinnati College of Medicine and medical director of the university’s ophthalmology clinics, told Healio. “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.”
However, fear of surgery appeared to have a link with vision quality. Of the seven patients with best corrected visual acuity worse than 20/40 in both eyes, none feared surgery. But among the five patients with BCVA worse than 20/40 in only one eye, 40% feared surgery. This is despite all 12 patients reporting a belief that cataract surgery improves vision.
The finding implies “that perhaps the patients with ‘worse’ vision had either already been counseled or simply felt their vision had more to benefit,” Hu said. “This cemented that patients truly value what their eyesight brings to daily functioning and quality of life, and that in speaking to patients, we have to recall this.”
Wey shared strategies to help patients overcome fears of cataract surgery.
Stephanie Wey
“It can be helpful to walk them through the surgery. I focus on talking about the team that is there to make sure the patient is comfortable, especially anesthesia,” she said. “I talk about how usually patients will experience fluid, pressure and varying lights and hear some noises and talking.
“To address their fears is to build a connection with them and understand their values. We are here to maintain their vision so that they can continue to live their best lives, whatever that means to them.”
Future research should examine these questions in different populations, Hu said.
“Given our small sample size of 42 participants in a Midwestern safety-net hospital who were primarily socioeconomically lower income and racially Black and Caucasian, we need more diverse environments and populations to investigate the generalizability,” she said.
“We might anticipate differences in populations who have less interfacing with the medical and health care systems, particularly as our patients were required to be established patients at our clinic. This could look like patients in more geographically rural areas.”
For more information:
Samantha Hu can be reached at hust@mail.uc.edu.
Lisa D. Kelly, MD, can be reached at kellyl5@ucmail.uc.edu.
Stephanie Wey, MD, can be reached at stephanie.wey@pennmedicine.upenn.edu.
