Dealing with Anxiety in Cataract Patients

Published: April 21, 2021

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Cataract removal is the most common surgical procedure performed in the U.S. Each year, some 3.6 million Americans undergo cataract surgery.(1) The success rate for the surgery is close to 99% and serious complications are very rare.(2) Still, as with any surgery, patients report anxiety beforehand. Anxiety can have a detrimental effect on the body. “It activates the sympathetic nervous system and is characterized by a rise in catecholamine levels, heart rate, blood pressure, and increased glucocorticoid levels. At its worst it may place an ischemic strain on the heart and cause hyperventilation or a panic attack.”(3)

A recent study found a convincing link between preoperative anxiety and pain. The study, published in the journal Ophthalmologist, involved asking patients to rate their anxiety before cataract surgery, and their pain after the surgery. The study found that patients with severe anxiety were 12.4 times more likely to experience severe pain. “From a physiological standpoint, there seems to be a clear relationship between anxiety and pain via the amygdala, whereby pain may induce anxiety, and anxiety may induce pain, leading to a vicious circle.”(4)

Providers have found a variety of strategies to help reduce anxiety in patients. This effort begins with the preoperative conversation, which is a time “to set realistic patient expectations regarding discomfort, level of consciousness, visual sensations, and complications.”(5) Assuring patients that it is very normal to feel nervous before the surgery can be helpful. Patients are generally awake during surgery, and can hear conversations between the physician, nurses, and other staff. Ensuring that everyone in the operating room is “on the same page” with protocols means that fewer questions need to be asked during the procedure. Overhearing questions can lead to worry for the patient.(5)

Some practices connect particularly anxious patients with patients who have gone through the procedure successfully and have volunteered to share their experience.(6) A study published in the Journal of Advanced Nursing examined the effect of handholding on anxiety in patients undergoing cataract surgery. Anxiety was measured by visual analogue scales and patient interviews, blood samples were taken to measure epinephrine, pulse rates and blood pressure were analyzed as a physiological measure of stress. Patients in the handholding group reported significantly decreased anxiety and had significantly lower epinephrine levels, indicating that the noninvasive intervention has the potential to decrease anxiety.(7)

Another study, presented at a meeting of the American Academy of Ophthalmology, examined the effect of binaural beat therapy on cataract patients. The therapy consists of two separate tones, delivered by earphones to each ear. “The technique evokes alpha-frequency brainwaves, a state that is linked to relaxation and reduced perception of fear and pain.” The researchers combined these tones with soothing music and nature soundscapes, such as ocean waves. The headphones also blocked the sounds that some patients can find upsetting – conversations between surgeons and staff, and the sounds of surgical machinery. “Patients who listened to a binaural beats-music mix before, during and after the procedure had less anxiety and slower heart rate, compared with the control group patients who did not receive the therapy.”(8)

For providers and institutions, Edge Pharma offers a wide range of ophthalmic products, including ophthalmic blocks, epi-shugarcaine (epinephrine 0.025%/lidocaine 0.75%) ceftazidime 22.5 mg/mL, lidocaine 1%/ phenylephrine 1.5%, moxifloxacin 1 mg/mL, and cefuroxime 10 mg/mL.

 


(1) Dallas, M. Healthgrade, The 10 Most Common Surgeries in the U.S., https://www.healthgrades.com/
(2) UCI Health, Cataract Surgery: What You Should Know, https://www.ucihealth.org/
(3) Astbury, N. Nature, A Hand to Hold: Communication During Cataract Surgery, https://www.nature.com/
(4) Harkin, P., The Ophthalmologist, Sick With Worry: Anxious Patients are 12.4 Times More Likely to Experience Pain During Cataract Surgery, https://theophthalmologist.com/
(5) Weiner, G. interviewing Oetting, T. M.D., Rosenfeld, S. M.D., Henderson, B. M.D, American Academy of Ophthalmology, Reducing Patient Anxiety During Surgery, https://www.aao.org/
(6) Ngoei, E. Eyeworld (The Journal of the American Society of Cataract and Refractive Surgery) Navigating Nerves in Cataract Patients, https://www.eyeworld.org/
(7) Moon, J., Cho., K. Journal of Advance Nursing, The Effects of Handholding on Anxiety in Surgery Patients Under Local Anesthesia, The Effects of Handholding on Anxiety in Cataract Surgery Patients Under Local Anesthesia, https://pubmed.ncbi.nlm.nih.gov/
(8) American Academy of Ophthalmology Annual Meeting, Soothing Sounds During Cataract Surgery Reduces Patient Anxiety, https://medicalxpress.com/