Fear and Anxiety Associated with Cataract Surgery Under Local Anesthesia in Adults: A Systematic Review

Figures & data

Table 1 Visual Sensations During Cataract Surgery as Fear Triggers

Author	Year	Sample Size	Setting	Main Findings
Chaudhry et al^Citation15	2014	53	Pakistan	26.4% of patients operated on cataract under topical anesthesia reported fear due to intraoperative visual sensations
Ang et al^Citation16	2007	98	Singapore	19.4% of operated due to cataract under topical anesthesia found their visual experience frightening
Au Eong et al^Citation17	2000	52	Singapore	15.4% of patients operated under topical anesthesia found their visual experience frightening
Au Eong et al^Citation18	2000	52	Singapore	7.1% of patients operated under retrobulbar anesthesia found their visual experience frightening
Rengaraj et al^Citation19	2004	306	India	10.4% in the topical anesthesia group and 9.3% in the retrobulbar anesthesia group found their visual experience frightening
Prasad et al^Citation20	2003	121	United Kingdom	3% of patients during phacoemulsification cataract surgery under sub-Tenon’s block found the visual experience frightening and 4% thought it to be unpleasant
Wickremasinghe et al^Citation21	2003	104	United Kingdom	13.5% of patients operated under subtenons anesthesia found the visual experience frightening. Frightening visual experiences were significantly associated with the perception of colour (P=0.005) and photophobia (P=0.003).

Table 2 Comparison Between Patients` Feelings During First- or Second-Eye Cataract Surgery

Author	Year	Sample Size	Setting	Main Findings
Mitsonis et al^Citation6	2006	278	Greece	During the first-eye surgery, patients experienced the greatest peak anxiety on the day of the surgery, while those operated on the second eye presented no fluctuations in rated anxiety
Fagerström et al^Citation7	1993	100	Finland	Positive experiences of the first-eye surgery, including its painless course and satisfactory improvement in vision, significantly reduced the fear of the second surgery and the fear of becoming blind
Foggitt et al^Citation8	2001	108	United Kingdom	In the preoperative period, anxiety is higher in patients operated for the first time, and in the postoperative period in those operated for the second eye
Ramirez et al^Citation10	2017	61	USA	Fear of being blinded and the operation as such prevailed before the first eye cataract surgery. In those operated on the second eye prevailed fear of intraoperative complications and lack of vision improvement.
Heard et al^Citation31	2020	198	USA	2/3 of patients who were “very or extremely anxious” during the first operation did not experience anxiety during the second-eye surgery
Ługowska et al^Citation32	2020	200	Poland	Patients experienced greater anxiety before their first-cataract surgery than before the second-eye surgery
Pager et al^Citation34	2005	160	Wales	Patients who had operated the second eye were less anxious prior to surgery and rated the second surgery as more comfortable than the first one
Yu et al^Citation35	2016	127	China	Patients experienced less anxiety, a greater number of eye bulges and pain during second cataract surgery compared to the first surgery
Adatia et al^Citation36	2015	292	Canada	42.8% patients rated second-eye surgery as more unpleasant procedure. 72% were similarly or more relaxed during the second operation. The second-eye cataract surgery was perceived as being a longer and more painful by 45.4% of patients

Table 3 Music Listened Before and During Cataract Surgery

Author	Year	Sample Size	Setting	Main Findings
Guerrier et al^Citation63	2020	310	France	Music listened to immediately before cataract surgery lowers the level of anxiety and reduces anxiety-related hypertension during surgery
Merakou et al^Citation64	2015	200	Greece	Music listened to before surgery lowers the level of anxiety and fear. Listening to music during surgery reduces anxiety level and overall blood pressure
Bringman et al^Citation65	2009	177	Sweden	Relaxing music decreases the level of anxiety in a pre-operative setting to a greater extent than orally administrated midazolam
Bellan et al^Citation66	2002	144	Canada	Oral sedation and listening to music before surgery were associated with decreased anxiety and increased levels of sedation
Muddanaet al^Citation67	2020	165	India	Music listened before and during cataract surgery presented reductions in self-reported anxiety before, during and after surgery and a significant decrease in postoperative blood pressure
Wiwatwongwana et al^Citation68	2016	141	Thailand	Intraoperative music was proven to decrease anxiety level and lower systolic blood pressure
Choi et al^Citation69	2018	52	Republic of Korea	Korean traditional music had a significant effect on reducing pain experienced by patients during cataract surgery
Camera et al^Citation70	2008	203	Hawaii, USA	Live classical piano music lowered the blood pressure, heart rate, and respiratory rate in patients undergoing ophthalmic surgery
Karwoski et al^Citation72	2010	93	USA	Patients having cataract surgery experienced less intra- and postoperative anxiety if they heard no music or music they had selected themselves as opposed to music selected by the operating surgeon
Cruise et al^Citation73	1997	120	Canada	Elderly patients undergoing cataract surgery under retrobulbar block were more satisfied if they heard relaxing music, rather than relaxing suggestions or white noise. The type of auditory stimuli did not influence the level of anxiety.

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