NEWS & OPINION 54 EWAP JUNE 2023 Impact of personality on the decision process and on satisfaction rates in pseudophakic presbyopic correction Ntonti P, et al. J Cataract Refract Surg. 2022;48:1433–1439. Purpose: Primary objective of this paper is to explore the impact of personality on the decision process and the satisfaction rates in pseudophakic presbyopic correction. Setting: Department of Ophthalmology, University Hospital of Alexandroupolis, Greece. Design: Prospective, comparative study. Methods: A consistent consultation was conducted in cataract patients that explained the benefits and the drawbacks of bilateral trifocal correction, which was offered at no extra cost. In all participants, personality was evaluated by the Traits Personality Questionnaire 5. Data modeling with decision trees and multiple regression analysis identified the contributions of personality traits in the decision process and the postoperative satisfaction. Results: Of 120 participants (60 men and 60 women), 81 (67.5%, 24 men, 57 women) selected premium correction. In men, low neuroticism and high extraversion were the primary personality contributors for selecting premium surgery. In women all personality traits contributed to the selection process. Women were more demanding in the expected postoperative distant acuity than men (0.1 vs 0.2 logMAR) in order to present high satisfaction. For both men and women, openness to experience, conscientiousness and extraversion are primary contributors for optimal satisfaction rates. Conclusion: Men and women demonstrate differences in the selection process for premium pseudophakic surgery and differences in the expected postoperative visual acuity. It seems that the personality of the patient plays a significant role in the perceived outcome following premium surgery. option (p=0.04). In men, low neuroticism and high extraversion were the primary characteristics associated with selection of the trifocal IOL option. In women, all personality traits appeared to contribute to the selection process. While a postoperative uncorrected distance visual acuity (UDVA) better than 0.1 logMAR resulted in maximal satisfaction in both men and women, women were less satisfied with postoperative UDVA worse than 0.1 logMAR; men were fairly satisfied unless their postoperative UDVA was worse than 0.3 logMAR. Uncorrected near visual acuity (UNVA) outcomes were similar between men and women, both requiring below 0.1 logMAR for high satisfaction rates. Of the subjects who underwent trifocal IOL implantation, multiple regression analysis revealed characteristics associated with higher postoperative satisfaction, which included openness to experience, conscientiousness, and extraversion. Low openness to experience in combination with high neuroticism was found to be more associated with low satisfaction. Discussion Though many pharmacologic and surgical options exist to address presbyopia, every option has its limitations. To date, no technology can entirely restore vision to a pre-presbyopic state. Thus, preoperative counseling to set patient expectations is arguably just as important as the procedure itself, and careful patient selection for premium IOL implantation is paramount to optimize postoperative satisfaction. This study revealed personality traits that may help predict premium IOL selection and satisfaction. For men, neuroticism and extraversion were key characteristics associated with the selection of a premium IOL. For women, the decision tree appeared more complex; interestingly, only three women self-selected into the control (monofocal IOL) group, making interpretation of IOL selection characteristics of women in this study challenging. This study suggests that a favorable patient profile associated with greater postoperative satisfaction after trifocal IOL implantation is one with higher levels of openness to experience in conjunction with high conscientiousness and extraversion. This study may not be entirely generalizable as there was careful selection of patient optical characteristics, and the typical out-of-pocket costs associated with premium IOL options were circumvented. EWAP References 1. Holden BA, et al. Global vision impairment due to uncorrected presbyopia. Arch Ophthalmol. 2008;126:1731–1739. 2. Labiris G, et al. Mini-monovision versus multifocal intraocular lens implantation. J Cataract Refract Surg. 2015;41:53–57. 3. Rudalevicius P, et al. Relations between patient personality and patients’ dissatisfaction after multifocal intraocular lens implantation: clinical study based on the five factor inventory personality evaluation. Eye (Lond). 2020;34:717–724. 4. Ntonti P, et al. Impact of personality on the decision process and on satisfaction rates in pseudophakic presbyopic correction. J Cataract Refract Surg. 2022;48:1433–1439.
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