Patient attitude influences perceived satisfaction

The psychological outlook of patients has enormous influence on their perception of quality of life after cataract surgery, even if the outcome is poor, said Oliver Findl, MD of Moorfields Eye Hospital, London, UK.

Some patients who end up with worse measured visual acuity (VA) remain quite satisfied with their quality of life. Conversely, some with better-measured VA are less satisfied. These findings have important implications for patient selection.

The results come from a study on the improvement of self-reported quality of life in cataract patients. The 105 patients included, completed a number of quality of life questionnaires before surgery and one month after surgery. Additionally they performed a subjective VA using the visual acuity scale (VAS), and were tested for best spectacle correction to establish VA.

Patients were grouped into four categories: good VA and good VAS (G1); good VA and poor VAS (G2); poor VA and good VAS (G3); and poor VA and poor VAS (G4).

In all groups together, significant improvements of the self-reported quality of life were detected in 18 of 26 dimensions of the test instruments. Deterioration was detected in the dimension 'physical role' limitations, probably due to late spectacle correction.

"Group G1 and G4 are as expected. G3 is a satisfaction paradox, their vision is poor, but they,re happy anyway. G2 is the opposite: they have good visual acuity, but they are not satisfied, it's a dissatisfaction paradox," Dr Findl noted.

"Mental health explains the differences. The 'happy but unfortunate' have good mental health. But the results also tell us that the 'fortunate but unhappy' have not so good mental health," Dr Findl explained.

Dr Findl noted that cataract surgery improves the self-reported quality of life in patients with age-related cataract. Categorising patients according to their own estimation of visual function and the measured VA seems a promising way to identify the causes for unhappiness after surgery, Dr Findl noted.

He added that doctors must to be sensitive to the patient's attitude. G3 type patients may not need surgery, G2 patients, on the other hand, need a very thorough informed consent. Corrected spectacles should be prescribed earlier. Finally, referral to a psychologist for additional help may be appropriate for G2 patients.