Visual experience during phacoemulsification under topical anaesthesia: a nationwide survey of Singapore ophthalmologists

Background:  All patients undergoing phacoemulsification under topical anaesthesia experience a variety of visual sensations that may be frightening in a small proportion of patients. This study evaluates Singapore ophthalmologists’ knowledge and practices regarding patients’ visual experience during phacoemulsification under topical anaesthesia. Methods:  A nationwide survey of all ophthalmologists in Singapore who had performed at least one cataract surgery within the last year was carried out. Questions regarding patients’ experience were asked. Surgeons were also asked about patients’ fear during surgery, usefulness of preoperative counselling and feedback from patients postoperatively. Results:  Of 105 ophthalmologists 89 responded, of which 44 performed phacoemulsification under topical anaesthesia. The percentage of respondents who thought that the patients experienced the various visual sensations were: no light perception (4.6%), light perception (97.7%), one or more colours (95.5%), flashes of light (77.3%), movements (90.9%), instruments (61.4%), surgeon's hands/fingers (56.8%), surgeon (47.7%) and change in brightness of light (90.9%). Although 52.3% of surgeons believed that patients may be frightened by their visual experience and 50.0% felt that preoperative counselling would be useful in reducing such fear, only 11.4% routinely offered preoperative counselling and 18.2% counselled their patients occasionally. In total, 50.0% ophthalmologists had patients who reported to them that they could see during surgery, whereas 20.5% had been told by patients that they were frightened by the visual experience. Conclusion:  Despite the awareness of patients’ visual experience and the belief that preoperative counselling may be useful, most ophthalmologists do not counsel their patients preoperatively.