FEATURE 10 EWAP JUNE 2022 by Ellen Stodola Editorial Co-Director Unhappy patients after cataract surgery: Reasons for dissatisfaction and how to help Even with a technically perfect outcome after cataract surgery, physicians may find that some patients are unhappy. This dissatisfaction can be due to a number of factors that go beyond visual outcome. Surendra Basti, MD, and Daniel H. Chang, MD, shared what can cause unhappiness and how they discuss it with patients. Dr. Basti said it’s not uncommon for patients to be unhappy after what is otherwise a successful cataract surgery. He said that about a quarter of patients who experience this dissatisfaction will not actually spell it out for the surgeon, but if you probe, you’ll get to why they are unhappy. In the majority of these cases, Dr. Basti thinks it’s a lack of proper understanding. “A proper conversation with the patient can potentially fiÝ the source of unhappiness,” he said. “Infrequently, there may be a need for surgery, but it depends on what the primary source of unhappiness is.” Dr. Basti generally groups unhappiness after otherwise perfect cataract surgery into three categories. The first are patients whose refractive outcomes or the point where they expected vision to be is not exactly where it is. The patient may be a little more or less This article originally appeared in the April 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Contact information Basti: sbasti@northwestern.edu Chang: dchang@empireeyeandlaser.com nearsighted than expected. It may be that the patient wanted to be able to read, and the surgeon targeted a refractive error of –2.0 or –2.25, but some people are used to reading at different distances than others. Frequently, it’s the distance for working or using a computer that patients are not happy about, Dr. Basti said, estimating that half of unhappy patients after successful surgery would fall into this category. The second category of unhappy patients Dr. Basti sees are those with quality of vision issues. This group would include patients experiencing dysphotopsia and those with multifocal lenses who don’t quite like the contrast sensitivity. He estimated that around 30% of the unhappy patients he sees after cataract surgery fall into this category. The third category of patients unhappy after cataract surgery are those with physical discomfort, like dry eye or a stinging sensation from eye drops, Dr. Basti said. This problem can usually be corrected and isn’t something that lasts. It is possible after surgery to be a little off from the target, Dr. Basti said, so it’s important to mention to patients that they may have to adjust the distance at which they’re reading. He always brings this up in the preoperative discussion. He is also very sensitive to treating dry eye preoperatively. “But sometimes a patient’s eyes might look moist, and after surgery, they find the medication uncomfortable. So on our postop sheet, we spell out that they may have discomfort from the eye drops, and using artificial tears is a good first line of defense.” Dr. Basti said he doesn’t overemphasize quality of vision in the preoperative discussion, but he will tell patients, “You can be fairly certain if you don’t like vision at end of this, there is the possibility of exchanging the lens.” Dr. Basti said that this is done infrequently. Similar to how Dr. Basti differentiated among the different complaints after cataract surgery, Dr. Chang suggested that these could be categorized as “visual” and “non-visual.” Visual complaints, Dr. Chang said, include positive and negative dysphotopsias. Positive dysphotopsias, such as glare, halo, and starbursts, are generally noticed at night when driving and are especially associated with presbyopia-correcting IOLs. Therefore, it’s important to counsel patients preoperatively and set expectations. “As a rule
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