Refractive surgery, while a life-changing procedure for many, can be a significant source of anxiety for patients. Anecdotally, we observed that highly anxious patients exhibit increased restlessness during surgery, potentially leading to a higher risk of complications. This underscores the importance of addressing anxiety before the procedure to enhance patient safety and surgical precision. Understanding the nature of this anxiety, its potential impact, and developing strategies to mitigate it are crucial for optimising patient experience and safety.
A recent pilot review funded by the Future Vision Foundation – Vision Eye Institute’s not-for-profit organisation supporting ophthalmic research – focused on exploring these aspects, providing valuable insights for our laser refractive clinics. The review aimed to understand patient anxiety and its impact on surgical procedures, with the further goal of integrating a range of further potential strategies.
A total of 209 consecutive patients undergoing laser refractive surgery at a single clinic were provided with the State Trait Anxiety Inventory (STAI) questionnaire before surgery and prior to pre-operative medication being administered. Patients were asked to rate feelings of being upset, frightened, nervous, jittery and confused. The data showed that nervousness was the most common emotion. Multiple studies have indicated that anxiety is often rooted in the fear of the unknown, concerns about potential complications, and the apprehension associated with surgical procedures, all of which are normal and expected.
To provide an understanding of how pre-operative anxiety matched the subjective operative experience, we then provided a Likert scale for patients to rate their discomfort levels immediately following their laser procedure. The results revealed a strong correlation between pre-operative feelings of fear, nervousness, and jitteriness, and post-operative discomfort scores. This suggests that anxiety affects not only the patient’s emotional state but also their physical perception of discomfort. It could also mean that anxious patients were not compliant with instructions during surgery, which could cause increased technical challenges for the surgeon, which may lead to more discomfort for the patient. This highlights the importance of addressing anxiety before surgery to improve patient comfort and satisfaction.
Further, post-operative scores showed that subjective discomfort was significantly correlated with patient age and surgeon. Younger patients reported more discomfort, and the surgeon choice played a role, though these factors are less modifiable. Of note, our findings indicated that overall, patients were generally not upset following surgery, suggesting that pre-surgery information provided by the clinic was likely effective in addressing initial concerns. However, there remains room for continued review and improvement.
Recognising the impact of anxiety, non-pharmacological interventions, such as music therapy, have been explored to reduce anxiety through surgery. As part of the extended project, our team is looking to introduce personalised music playlists through the use of headphones to the refractive suite and investigate if this may help further. This project is ongoing, and findings are anticipated to contribute to developing effective anxiety management strategies.
Our review, which was also recently presented as a RANZCO Congress poster, has yielded several key findings. STAI scores effectively identify pre-operative patient state and their potential impact on post-operative perceptions. However, the pilot review confirmed that no single pre-operative metric was ideal at predicting perceived discomfort, suggesting that subjective evaluation represents a part of the broader experience. Pre-operative preparation should be tailored to individual patient anxiety levels and age. The use of a short pre-operative questionnaire may assist in the identification of patients who appear comfortable yet may have higher internal anxiety.
Ideally, clinics should foster a culture of open communication where patients feel comfortable discussing their concerns and provide comprehensive pre-operative education. Surgeons should be aware of the potential impact of patient anxiety on surgical outcomes and take steps to create a calm and reassuring environment. Ongoing support and follow-up should be provided to address any post-operative concerns and ensure patient comfort.
By implementing these strategies, ophthalmology clinics can create a more positive and supportive environment for patients undergoing laser refractive surgery, ultimately leading to improved surgical outcomes and patient satisfaction. The integration of data from tools like STAI, alongside an understanding of patient demographics, allows for a more tailored and effective approach to patient care. We look forward to providing a further update on the impact of music in the refractive suite.
ABOUT THE AUTHOR:
Name: Shih Shih Ta
Qualifications: BAppSc (Orthoptics)
Affiliations: National manager of patient experience & projects, Vision Eye Institute.
Location: Sydney
Years in industry: 23
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