Dear Editor,

We read with interest the article ‘Randomised controlled trial of preoperative information to improve satisfaction with cataract surgery’ by Pager [1]. The study showed that a preoperative videotape session describing the experience of day-stay cataract surgery resulted in significant increase in overall satisfaction during the immediate postoperative period.

Patient satisfaction has drawn increasing attentions in all field of medicine for medical, financial, and litigation reasons. Age, types of aphakic correction, information received by patients, ocular comorbidity, and postoperative visual acuity have been identified as important factors affecting the overall satisfaction in patients undergoing cataract surgeries [2]. While this study addressed the psychosomatic response in the perioperative period, it would be interesting to know how the videotape session can affect the perception of surgical outcome. It would be even more worthwhile to assess how such videotape session can modify the patient response to unfavourable outcomes when surgical complications occur. Further information of patient satisfaction in either group during the follow-up period would be relevant.

It was shown that the majority of patients could not recall relevant information after verbal consent [3]. The information was deteriorated significantly after operation, even more so in those with advanced age and less than high school education [3]. Therefore, videotape has been attempted in the informed consent process by other medical fields. Patients having gastrointestinal endoscopy were found to be more satisfied with videotape followed by physician discussion than either method alone [4]. It has also been demonstrated to lead to higher knowledge scores, especially in patients with lower education levels [5]. Since cataract patients are usually old and come with very high expectation, we feel that further research is required to explore the use of videotape in order to achieve a better informed consent.

References

1. Pager CK. Randomised controlled trial of preoperative information to improve satisfaction with cataract surgery. Br J Ophthalmol 2005;89:10- 13.

2. Legro MW. Quality of life and cataracts: A review of patient- centered studies of cataract surgery outcomes.

3. Morgan LW, Schwab IR. Informed consent in senile cataract extraction. Arch Ophthalmol 1986;104:42-5.

4. Agre P, McKee K, Gargon N, Kurtz RC. Patient satisfaction with an informed consent process. Cancer Pract 1997;5:162-7.

5. Rossi M, McClellan R, Chou L, Davis K. Informed consent for ankle fracture surgery: patient comprehension of verbal and videotaped information. Foot Ankle Int 2004;25:756-62.