PATIENT STRESS IN CATARACT SURGERY ATTEMPT TO IDENTIFICATION OF ORIGIN

1. PATIENT STRESS IN CATARACT SURGERYATTEMPT TO IDENTIFICATION OF ORIGIN The authors of this e-poster have received travel expense reimbursement from ALCON . The authors have no financial interest in the subject matter of this e-poster. François A Blondeau MD Le Château d’Olonne FRANCE ASCRS San Diego March 25-29 2011 Rich Wilson Vendee Globe March 11 2009

2. Is a patient sedation as mandatory as usually said in cataract surgery ? This study tries to identify what can have been a factor of stress and gives some paths to avoid useless medication and heavy medical environment

3. Document on next slide has to be given to patient before cataract surgery and patient signature is requested to certify that patient information on surgery is complete. This text is very different of the text to be read on ASCRS web site : The anesthesiologist’s opinion as well as his/herpresence, are described as necessary A hospital structure isdescribed as the environment of choice 18 risks are given among them per operative infection with a rate of 1to 3 out of 1000 surgeries Patient is advised : “There is no surgery without risk” and : “Total loss of the eye function or the eye itself may occur”. Some patients give up the surgery.

5. This readingmaycreatesome images far fromserenity

6. ASCRS information : MethodsAuthor makes a retrospective survey on more than 2000 consecutive procedures of cataract surgery ( and intra vitreal injections ) performed under topical anesthesia in a French ambulatory surgical center without sedation in standard procedure. “If you’re feeling nervous about lens replacement for your cataracts, keep in mind-modern cataract surgery is one of the safest and most effective medical procedures performed today. It helps about 3 million people each year in the U.S. alone, with an overall success rate of 98% or higher. It may also make you feel more confident if you know what you can expect every step of the way-from your initial evaluation to the day of the surgery… Many patients ask their spouse, friend or caregiver to attend their pre-operative appointment, to serve as an extra set of ears to hear the doctor's recommendations and directions.”

7. Patient knows the face and the name of each professional  he meets at the office Once he has entered the surgery room, he is glad to recognize the voice of the nurse  who gave him all the useful recommendations a few days earlier Office based surgery does not induce stress as much as wide hospitalization structures do.

8. 2230SURGERIES have been performed between November 26, 2006 and February 15, 2011 (39 months) Cataract extraction with IOL : 1801 Intravitreal injections : 429 AVERAGE AGE of PATIENT at TIME of SURGERY 72 ½ FROM 25 ¾ TO 97 ¼ NO INTRACAMERAL INJECTION OF ANTIBIOTIC AT END OF SURGERY

9. Results :Nosedation was the standard procedure for all the patients. As next slide shows more than 100 surgeries were performed in patients with psychiatrics treatments without any change of this treatment.Nearly 150 were performed on patients with medical treatments for depression As next slide shows some where suffering of ALZEIMER, PARKINSON OR EPILEPSY A light sedation has been used for only 2 patients on their demand.No general anesthesia had to be performed on any patient Otherassociated pathologies are compiled on next slide. Medical Outcome Measurements are Endophthalmitis or TASS rates and Patient Satisfaction. Endophthalmitis rate = 0 ToxicAnterior Segment Syndrome rate = 0

11. A satisfaction questionnaireisgiven to patients followingNF ISO 9001 2000 certification requirements This questionnaire isshown on nextslide Questions are about Quality of receptionat the facility Waitingdelayat the facility Quality of information given by surgeon duringappointment Quality of information given by staff duringappointment Quality of information given by staff duringstay for surgery Quality of information about surgerygiven in written documents Quality of care beforesurgery Quality of care aftersurgery Quality of pain care during and aftersurgery Suggestions Overall satisfaction

13. Reception at the facility reaches the best performance of quality when written information given to the patient remains a little less efficient that we had hoped . Information given by Surgeon himself, the Nurse or the staff is more efficient. Less satisfaction for waiting delay before surgery – for pupil dilatation - may be explained by stress of patient who did not received sedation but was never a factor during surgery (perception of the quality of pain care is the same than perception of quality of information).

14. Conclusion This retrospective survey demonstrates that anaesthesiology environment ( or patient sedation most of times ) is useless for cataract surgery procedures in patients even with heavy stabilized pathologies.A good information of patient ( and his closest relatives as suggested on ASCRS web site ) showing the safety and effectiveness of the procedure appears to be very efficient .Analyse shows a little advantage of direct information compared to written.A confident patient may have surgery without any sedation. This is helpful for the care of elderly patients or patients with heavy pathologies ( ASA 3 ).Waiting time during pupil dilatation is an important factor which demands high quality of staff.