Cataracts remain a leading cause of reversible blindness worldwide, and disparities in surgery uptake persist across both low- and high-income countries. A new study sought to determine whether health literacy influences fear of cataract surgery and vision loss in patients who hadn't previously undergone the procedure. Researchers aimed to identify whether improving patient education might alleviate surgery-related anxiety.

Participants aged 50 years and older with a clinical diagnosis of cataract and no history of cataract surgery were surveyed. All the participants spoke English and were established patients at the clinic, which was a “safety-net clinic”—a tertiary hospital-based eye clinic that largely serves Cincinnati’s uninsured and underinsured population. Surveys assessed:

• Demographics and income

• Understanding of cataract symptoms, pathology, and treatment

• Fear of cataract surgery and vision loss

• Health literacy, measured using the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF).

Statistical analysis was conducted using t-tests and chi-squared tests.

The participants were an average of 66.2 years and over half (59.5%) were female. More than half (59.5%) identified as Black. Most (85.3%) had at least a high school education, and 40.5% reported annual income below $20,000.

About one-third of the participants (36%) reported fear of undergoing cataract surgery. Slightly more than half reported fear of vision loss, and 30% reported daily worry. A significant association existed between fear of surgery and skepticism that surgery would improve vision (P = .03), but no significant link was observed between fear of vision loss and belief in surgical benefits (P = .92).

Patients with best corrected visual acuity (BCVA) worse than 20/40 in both eyes showed no fear of surgery, but those with BCVA worse than 20/40 in only one eye exhibited higher fear of surgery. Among patients with BCVA better than 20/40 in both eyes, 33.3% expressed fear of surgery.

Ultimately, health literacy wasn't associated with knowledge of cataract pathology or belief in the efficacy of surgery. Most patients (80%) scored a 7 on the REALM-SF, which indicated a 9th-grade reading level or higher, and no significant association was found between REALM-SF scores and fear of cataract surgery (P = .87).

“Rather, vision is a critical factor in perception; patients with better vision fear cataract surgery more,” wrote lead study author Samantha Hu, of the University of Cincinnati College of Medicine, and colleagues. However, the researchers explained that it was unclear whether patients with poorer vision because of cataracts believed that the benefits of surgery outweighed the risks as a result of their provider’s advice or their own independent research.

Patients with better vision likely can still compensate well enough with their better-seeing eye and believe that surgery doesn't yet outweigh the risks. “It could be more beneficial to counsel patients early on, prior to the development of visually significant cataracts, so patients are properly equipped to pursue cataract surgery when their symptoms become bothersome,” the study authors suggested. “Improved education about new safer surgical techniques with uncomplicated small incision cataract surgery, manual small incision cataract surgery, and concurrent microinvasive glaucoma surgery in patients with ocular hypertension and glaucoma will also be needed,” they added.

The researchers acknowledged the study’s limited generalizability in addition to other limitations regarding participants’ demographics.

“Regardless of a patient’s current vision, anxiety surrounding one’s future vision remains. Thus, addressing patient fears and clarifying surgical goals should be prioritized, particularly for those with early, non-visually significant cataracts,” the study authors concluded.

No conflicts of interest were reported.

Source: Clinical Ophthalmology