Lanjutan ke – 3, CATARACT SURGERY PREOPERATIVE EVALUATION

  • 28/06/2021
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IV. PATIENT EXPECTATIONS

As discussed throughout this chapter, individualized surgical planning must occur for each patient. Patients have varying visual requirements and expectations regarding cataract surgery. The most important conversation between the patient and the surgeon is to adequately address patient expectations. Key issues to address include postoperative visual expectations, visual potential, uncorrected visual goal and the need for visual aids outside that range, the surgical experience, surgical and postoperative risks, and postoperative care.

In order to meet or exceed patient expectations of surgical outcomes, the surgeon needs to know what symptoms have brought the patient to seek surgery. It is best to summarize and focus on addressing specific objective symp- toms such as eliminating glare while driving at night or improving the ability to read road signs. If the patient has concurrent ocular pathology, it is important to remind him or her of how this condition may limit the postoperative visual outcome of cataract surgery. It is up to the surgeon to ensure that the patient has a realistic expectation of the visual outcome prior to consenting for surgery.

In addition, cataract surgery has the unique opportunity to change the patient’s uncorrected refraction postoperatively. It is therefore important to include in the preoperative discussion the uncorrected visual goal for each surgery. Each patient has individual interests resulting in individual visual needs. For example, some myopic patients may prefer to remain myopic for near work, such as avid readers; while distance vision may be more impor- tant to golfers. Other patients prefer spectacle independence with monovision correction or the use of accommodative or multifocal lenses. If these issues are not addressed preoperatively, an otherwise successful surgery can lead to an unsatisfied patient. Identifying the patient’s visual needs and then choos- ing the correct lens and postoperative refractive goal is crucial to meet the expectations of the patient.

Although cataract surgery is a very successful operation, there are risks associated with the operation that may complicate the outcome of surgery. We believe that patients should be informed of the potential complications associated with the surgery before they commit to consenting for the operation. During the surgery discussion, we review the potential for ptosis, endophthalmitis, corneal decompensation, retinal detachment, CME, and suprachoroidal hemorrhage in layman’s terms for them. If they have concurrent ocular conditions that increase the risks of surgery, we try to emphasize and review that risk to the individual as well.

The surgical experience is typically well tolerated for most patients. However, the uninformed patient is likely to have much more anxiety about surgery. Specific information that should be provided include where and when to report for surgery, expected duration of the surgery, expected total time at the surgical center, method of anesthesia and sedation and how patients tolerate it, expected amount and duration of pain, patient responsibilities the evening after surgery, when and where to report the day after surgery, and future appointments. Often a typed sheet with the above information is helpful to the patient.

Most patients have a friend or relative who had a wonderful experience with cataract surgery. While this is a credit to the profession of ophthalmology, it may create difficulties for the surgeon to match the patient’s experience to that of his or her peers. Patients should realize that cataract surgery is indeed surgery and although it usually proceeds without difficulty, com- plications can occur even if the surgery goes perfectly. This conversation is delicate because the surgeon must not induce unnecessary fears while providing an accurate representation of the risks. As always an honest approach is best.

*Dikutip dari Buku Essentials of Cataract Surgery 2nd Ed, halaman 18-19

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