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Visual experiences during cataract surgery: what anaesthesia providers should know

Published online by Cambridge University Press:  02 June 2005

Colin S. H. Tan ,
Kah-Guan Au Eong  and
Chandra M. Kumar
Colin S. H. Tan
Affiliation:
The Eye Institute, Tan Tock Seng Hospital, National Healthcare Group, Singapore
Kah-Guan Au Eong
Affiliation:
The Eye Institute at Alexandra Hospital; The Eye Institute at Tan Tock Seng Hospital; National University of Singapore, Department of Ophthalmology; and Singapore Eye Research Institute, Singapore
Chandra M. Kumar
Affiliation:
The James Cook University Hospital, Academic Department of Anaesthesia, UK
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Summary

Recently published literature shows that most patients experience a variety of visual sensations during cataract surgery under local anaesthesia. Most patients (80–100%) retain at least some light perception in the operated eye and many also experience a variety of other visual sensations during cataract surgery under regional ophthalmic anaesthesia (retrobulbar, peribulbar and sub-Tenon's blocks) or topical anaesthesia. The visual sensations experienced include perception of movements, flashes, colours, changes in brightness, or the sight of surgical instruments, the surgeon's hands or fingers, or even the surgeon. These findings are clinically significant because 3–16.2% of patients who had cataract surgery under either regional or topical anaesthesia were frightened by their intraoperative visual experience. Fear and anxiety may cause some patients to become uncooperative during the surgery and may also induce a sympathetic stress response that might cause hypertension, tachycardia with myocardial ischaemia, hyperventilation or an acute panic attack. These effects are especially undesirable as the majority of cataract patients are elderly and have concurrent medical problems. Besides increasing the risk of intraoperative complications, a frightening visual experience may decrease patient satisfaction. Appropriate preoperative counselling has been shown to be effective in reducing the patients' fear. As most patients retain some visual function during cataract surgery under local anaesthesia, anaesthesia providers should be mindful of this phenomenon and offer appropriate preoperative information and counselling to their patients.

Keywords

CATARACT SURGERY, intraoperative visual experience, visual sensations, fear, preoperative counsellingLOCAL ANAESTHESIA, topical anaesthesia, peribulbar anaesthesia, retrobulbar anaesthesia, sub-Tenon's anaesthesia
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 6 , June 2005 , pp. 413 - 419
Copyright
© 2005 European Society of Anaesthesiology

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References

Buch H, Vinding T, Nielsen NV. Prevalence and causes of visual impairment according to World Health Organization and United States criteria in an aged, urban Scandinavian population: the Copenhagen City Eye Study. Ophthalmology 2001; 108: 2347–2357.Google Scholar
Weih LM, VanNewkirk MR, McCarty CA, Taylor HR. Age-specific causes of bilateral visual impairment. Arch Ophthalmol 2000; 118: 264–269.Google Scholar
Broman AT, Munoz B, Rodriguez J, et al. The impact of visual impairment and eye disease on vision-related quality of life in a Mexican-American population: Proyecto VER. Invest Ophthalmol Vis Sci 2002; 43: 3393–3398.Google Scholar
Taylor HR. Cataract: how much surgery do we have to do? Brit J Ophthalmol 2000; 84: 1–2.Google Scholar
Norregaard JC, Schein OD, Bellan L, et al. International variation in anaesthesia care during cataract surgery: results from the International Cataract Surgery Outcomes Study. Arch Ophthalmol 1997; 115: 1304–1308.Google Scholar
Leaming DV. Practice styles and preferences of ASCRS members – 2003 survey. J Cataract Refract Surg 2004; 30: 892–900.Google Scholar
Agency for Healthcare Research and Quality. Evidence Report/Technology Assessment: Number 16: Anaesthesia Management During Cataract Surgery. Accessed from http://www.ahcpr.gov/clinic/epcsums/anestsum.htm on 18 November 2004.
Rubin AP. Complications of local anaesthesia for ophthalmic surgery. Brit J Anaesth 1995; 75: 93–96.Google Scholar
Hamilton RC. A discourse on the complications of retrobulbar and peribulbar blockade. Can J Ophthalmol 2000; 35: 363–372.Google Scholar
Ruschen H, Bremner FD, Carr C. Complications after sub-Tenon's eye block. Anesth Analg 2003; 96: 273–277.Google Scholar
Haberer JP. Premedication and sedation complications during ophthalmic anaesthesia. J Fr Ophthalmol 2000; 23: 901–906.Google Scholar
Katz J, Feldman MA, Bass EB, et al. Adverse intraoperative medical events and their association with anaesthesia management strategies in cataract surgery. Ophthalmology 2001; 108: 1721–1726.Google Scholar
Au Eong KG. 6th Yahya Cohen lecture: visual experience during cataract surgery. Ann Acad Med Singapore 2002; 31: 666–674.Google Scholar
Au Eong KG, Lee HM, Lim ATH, Voon LW, Yong VSH. Subjective visual experience during extracapsular cataract extraction and intraocular lens implantation under retrobulbar anaesthesia. Eye 1999; 13: 325–328.Google Scholar
Au Eong KG, Low CH, Heng WJ, et al. Subjective visual experience during phacoemulsification and intraocular lens implantation under topical anaesthesia. Ophthalmology 2000; 107: 248–250.Google Scholar
Au Eong KG, Lim TH, Lee HM, Yong VSH. Subjective visual experience during phacoemulsification and intraocular lens implantation using retrobulbar anaesthesia. J Cataract Refract Surg 2000; 26: 842–846.Google Scholar
Newman DK. Visual experience during phacoemulsification cataract surgery under topical anaesthesia. Brit J Ophthalmol 2000; 84: 13–15.Google Scholar
Murdoch IE, Sze P. Visual experience during cataract surgery. Eye 1994; 8: 666–667.Google Scholar
Tranos PG, Wickremasinghe SS, Sinclair N, et al. Visual perception during phacoemulsification cataract surgery under topical and regional anaesthesia. Acta Ophthalmol Scand 2003; 81: 118–122.Google Scholar
Wickremasinghe SS, Tranos PG, Sinclair N, Andreou PS, Harris ML, Little BC. Visual perception during phacoemulsification cataract surgery under subtenons anaesthesia. Eye 2003; 17: 501–505.Google Scholar
Prasad N, Kumar CM, Patil BB, Dowd TC. Subjective visual experience during phacoemulsification cataract surgery under sub-Tenon's block. Eye 2003; 17: 407–409.Google Scholar
Levin ML, O'Connor PS. Visual acuity after retrobulbar anaesthesia. Ann Ophthalmol 1989; 11: 337–339.Google Scholar
Pang MP, Fujimoto DK, Wilkens LR. Pain, photophobia, and retinal and optic nerve function after phacoemulsification with intracameral lidocaine. Ophthalmology 2001; 108: 2018–2025.Google Scholar
Au Eong KG, Low CH, Heng WJ, et al. Retained visual sensation during cataract surgery [letter]. Ophthalmology 2001; 108: 1003–1005.Google Scholar
Singh R, Goyal D, Vasavada AR. Entoptic narration during phacoemulsification by an ophthalmologist. J Cataract Refract Surg 2002; 28: 9–10.Google Scholar
Sumich PM, Francis IC, Kappagoda MB, Alexander SL. Artist's impression of endocapsular phacoemulsification surgery. J Cataract Refract Surg 1998; 24: 1525–1528.Google Scholar
Verma D. Retained visual sensation during cataract surgery [letter]. Ophthalmology 2001; 108: 1004.Google Scholar
Sumich PM, Francis IC, Kappagoda MB, Alexander SL. Retained visual sensation during cataract surgery [letter]. Ophthalmology 2001; 108: 1003.Google Scholar
Winder S, Walker SB, Atta HR. Ultrasonic localization of anaesthetic fluid in sub-Tenon's, peribulbar, and retrobulbar techniques. J Cataract Refract Surg 1999; 25: 56–59.Google Scholar
Birch AA, Evans M, Redembo E. The ultrasonic localization of retrobulbar needles during retrobulbar block. Ophthalmology 1995; 102: 824–826.Google Scholar
Kumar CM, McNeela BJ. Ultrasonic localization of anaesthetic fluid using sub-Tenon's cannulae of three different lengths. Eye 2003; 17: 1003–1007.Google Scholar
Jay WM, Aziz MZ, Green K. The effect of retrobulbar lidocaine injection on ocular and optic nerve blood flow. Curr Eye Res 1986; 5: 429–432.Google Scholar
Verma L, Arora R, Kumar A. Temporary conduction block of optic nerve after retrobulbar anaesthesia. Ophthalmic Surg 1990; 21: 109–112.Google Scholar
Ramsay AS, Ray-Chaudhuri N, Dayan M, Walshaw D. Quantification of relative afferent pupillary defects induced by posterior sub-Tenon's, peribulbar, and retrobulbar anaesthetics. Brit J Ophthalmol 2001; 85: 1445–1446.Google Scholar
Lavinsky J, Gus PI, Ehlers JA, Roehe D, Nora DB. Visual-evoked potentials: assessment of retrobulbar and peribulbar anaesthesia. J Cataract Refract Surg 2000; 26: 1529–1532.Google Scholar
Schimek F, Steuhl KP, Fahle M. Retrobulbar blockade of somatic, motor, and visual nerves by local anaesthetics. Ophthalmic Surg 1993; 24: 171–180.Google Scholar
Ropo A, Ruusuvaara P, Setala K. Visual evoked potentials after retrobulbar or periocular anaesthesia. Brit J Ophthalmol 1992; 76: 41–43.Google Scholar
Heuermann T, Anders N, Pham DT, Wollensak J. [The effect of retrobulbar anaesthesia on visual evoked responses.] Klin Monatsbl Augenheilkd 2002; 219: 101–108.Google Scholar
Brent BD, Singh H. The effect of retrobulbar anaesthesia on visual acuity in planned extracapsular cataract extraction. Ophthalmic Surg 1991; 22: 392–395.Google Scholar
Talks SJ, Chong NHV, Gibson JM, Francis IR. Visual acuity and pupillary reactions after peribulbar anaesthesia. Brit J Ophthalmol 1994; 78: 41–43.Google Scholar
Scott RAH, Acharya PA, Jake Man CM, Perry SR. Peribulbar anaesthesia. Brit J Ophthalmol 1994; 78: 592.Google Scholar
Doden W, Bopp M. [Blockade of the optic nerve caused by retrobulbar anaesthesia.] Klin Monatsbl Augenheilkd 1984; 184: 311–312.Google Scholar
Pianka P, Weintraub-Padova H, Lazar M, Geyer O. Effect of sub-Tenon's and peribulbar anaesthesia on intraocular pressure and ocular pulse amplitude. J Cataract Refract Surg 2001; 27: 1221–1226.Google Scholar
Arora R, Verma L, Kumar A, Kunte R. Peribulbar anaesthesia and optic nerve conduction. J Cataract Refract Surg 1991; 17: 506–508.Google Scholar
Coupland SG, Deschenes MC, Hamilton RC. Impairment of ocular blood flow during regional orbital anaesthesia. Can J Ophthalmol 2001; 36: 140–144.Google Scholar
Verma D. Visual sensation in cataract surgery [letter]. Ophthalmology 2001; 108: 2158.Google Scholar
Khan AO. Visual sensation in cataract surgery. Ophthalmology 2001; 108: 2157–2158.Google Scholar
Tan CS, Rengaraj V, Au Eong KG. Visual experiences of cataract surgery. J Cataract Refract Surg 2003; 29: 1453–1454.Google Scholar
Au Eong KG. The Royal College of Ophthalmologists cataract surgery guidelines: what can patients see with their operated eye during cataract surgery? Eye 2002; 16: 109–110.Google Scholar
The Royal College of Ophthalmologists. Cataract Surgery Guidelines. London: The Royal College of Ophthalmologists, 2004.
Astbury NJ. The Royal College of Ophthalmologists Cataract Surgery Guidelines: what can patients see with their operated eye during cataract surgery? Eye 2003; 17: 285–286.Google Scholar
Leo SW, Au Eong KG. Comments on anaesthesia for cataract surgery. J Cataract Refract Surg 2003; 29: 633–635.Google Scholar
Rengaraj V, Radhakrishnan M, Au Eong KG, et al. Visual experience during phacoemulsification under topical vs. retrobulbar anaesthesia: Results of a prospective, randomized, controlled trial. Am J Ophthalmol 2004; 138: 782–787.Google Scholar