Patient Perspectives and Concerns Regarding Cataract Surgery and Cataract Surgery Sedation: A Qualitative Study

Liam Molina,1 Nora Lyang,2 Rachel Schwartz,1,3 Neeti Parikh,1,4 Saras Ramanathan,1,4 Alison J Huang,1,5,6 Catherine L Chen1,3,7 1School of Medicine, University of California San Francisco, San Francisco, CA, USA; 2Western University of Health Sciences, Pomona, CA, USA; 3Department of Anesthesia & Perioperative Care, University of California, San Francisco, CA, USA; 4Department of Ophthalmology, University of California, San Francisco, CA, USA; 5Department of Medicine, University of California, San Francisco, CA, USA; 6Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; 7Philip R. Lee Institute for Health Policy Studies at UCSF, University of California, San Francisco, CA, USACorrespondence: Liam Molina, School of Medicine, University of California San Francisco, 533 Parnassus Ave, San Francisco, CA, 94143, USA, Email [email protected] of Study: Given the low inherent risk posed by modern cataract surgery, there is ongoing debate regarding the need for anesthesia personnel for this procedure. However, few studies report patient perspectives about cataract surgery sedation. We sought to characterize patient perspectives regarding their experiences undergoing cataract surgery with monitored anesthesia care (MAC) and their willingness to consider cataract surgery with sedation alternatives to MAC.Methods Used: Semi-structured interviews were conducted with 9 patients (4 women) who recently underwent routine cataract surgery at the University of California, San Francisco. Participants were recruited from the Parnassus Outpatient Surgery Center. Interviews were recorded, de-identified, transcribed, and analyzed using an inductive thematic analysis approach. We ascertained the most relevant themes related to patients’ experience with cataract surgery and their perspectives on alternatives to anesthesia-led sedation during routine cataract surgery.Summary of Results: We found that patients are most concerned about achieving the best surgical outcome due to the importance they placed on preserving their vision. They expressed their fear of disrupting surgery intraoperatively and shared that they experienced a relative lack of communication about sedation in advance of surgery. However, while patients expressed a strong preference for anesthesia-led sedation during cataract surgery, they conveyed their openness to considering sedation alternatives in the presence of appropriate perioperative education, the availability of recent evidence supporting the safety of alternative approaches for cataract surgery, and their strong trust in their ophthalmologist’s professional recommendations.Conclusion: Patients prefer anesthesia-led sedation for cataract surgery but are willing to consider alternatives to MAC if the published evidence and their ophthalmologist attest that the alternatives are safe and effective.Keywords: qualitative study, patient perspectives, cataract surgery sedation, monitored anesthesia care, cataract surgery, patient interviews