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We read with great interest the results of the pilot study comparing patient satisfaction between topical and sub-Tenon’s anaesthesia.1 In conclusion, the authors state that sub-Tenon’s block produces higher satisfaction scores than topical anaesthesia.1
The scores used were obtained using the Iowa Satisfaction with Anesthesia Scale (ISAS), which has been used many times during other forms of surgery.2
However, the ISAS has not been used in the setting of unmonitored anaesthetic care and has not as yet been fully validated in a purely local anaesthetic environment. Dexter, who was part of the team that developed the ISAS, has said that the ISAS is still to be validated in this setting. Therefore, we would suggest that the conclusions that sub-Tenon’s anaesthesia gives better satisfaction than topical anaesthesia, purely based on this scale, is slightly premature.
The ISAS is due to be validated soon using local anaesthesia and sedation3; however, it is still used specifically during monitored anaesthetic care and is as yet not tested on unmonitored anaesthetic care, which is often found during topical cataract lists.