Dear Editor

We read with interest the article by Elder and Suter about what patients would like to know before having cataract surgery.[1] We congratulate the authors on investigating an area that has obviously been overlooked in ophthalmology. However we feel they failed to recognise some unique aspects of our specialty and also think that the nature of their study limits its practical application.

Firstly, one area that we feel is all too often left out of discussions with patients prior to cataract surgery is the intended refraction. The fact that the authors did not ask if patients would like to be informed of this supports our suspicions. Many patients may not even know that the surgeon can choose their focusing distance. Contact lens wearers with a unilateral cataract may like to decide if the refractive status of both eyes should remain the same or if the operated eye should be emmetropic so that they only have to wear one contact lens. Some patients may be interested in monovision, which has been highly successful in self-selected patients [2] and is easily remedied with spectacles if patients cannot tolerate it. Unlike many other areas of surgery, cataract surgery has an additional functional and cosmetic side to it that we feel patients need to have some awareness of before they can give their informed consent to the operation.

The authors chose to analyse differences between male and female patients. The purpose of doing this was not given in the aims, and we fail to see any useful application of this information. Would it not have been of more use to analyse the views of one-eyed patients who are putting all their good vision on the line? It would seem sensible to provide information at a level that satisfies those patients that have the most to lose.

We also feel that the very nature of their study makes it difficult to draw conclusions. Are patients indeed aware of just how many different complications there are that have a 1 in 10,000 chance of occuring? Are they really interested in the details of expulsive choroidal haemorrhage, uveitis-glaucoma-hyphaema syndrome, or prolonged hypotony due to an inadvertent persistant filtering bleb? Would they want to know about a risk if it is less than background rates of visual loss? We currently give patients an information leaflet that includes an estimate of the chance of visual loss then broadly explains the types of complications that can occur. We suspect that were we to produce written information detailing all complications that occur with a frequency of 1 in 10,000 that many patients, if asked, would prefer our original leaflet. As such, and until a well thought out study is done that shows otherwise, we will continue to provide this same amount of risk information to patients.

References

1. Elder MJ, Suter A. What patients want to know before they have cataract surgery. Br J Ophthalmol 2004;88:331-2.

2. Greenbaum S. Monovision pseudophakia. J Cataract Refract Surg 2002;28:1439-43.