title: Patients' visual experience during phacoemulsification cataract surgery and associated fear.
abstract: BACKGROUND
  Data from several published studies indicate that patients undergoing phacoemulsification cataract surgery can experience a variety of visual sensations which can result in fear. This phenomenon has not been studied in Pakistan to-date. We examined the visual experience and its associated fear among patients undergoing phacoemulsification cataract surgery under topical anaesthesia.
  
  
  METHODS
  This cross-sectional study was carried out in Aga Khan University Hospital, a tertiary care hospital, in Karachi, Pakistan from August 2010 to July 2011. Adults >18 years of age scheduled to undergo cataract surgery (phacoemulsification with intraocular lens implantation) under topical anaesthesia by a single surgeon were included. A structured questionnaire was used to collect data on socio-demographics, intraoperative visual experiences and subsequent reaction to these sensations. Participants were asked if they experienced visual sensations such as colours, shapes and movements during surgery. Moreover, they were asked if they developed fear due to these sensations.
  
  
  RESULTS
  Fifty three patients (mean age: 60.4 ± 12.4 years) were enrolled. Thirty (56.6%) of them were men and 23 (43.4%) were women. All of them reported having experienced visual sensations during surgery, the most common being light perception (100%), different colours (77.4%), movements of instruments or surgeon's hands (37.7%) and different shapes (7.5%) such as circles, clouds and patches. The most common colours perceived included white (46.2%), blue (35.8%), red (30.2%) and yellow (30.2%). One out of every four (26.4%) participants reported having developed fear due to these visual sensations. Only 4 (7.5%) reported having received preoperative counselling regarding such sensations.
  
  
  CONCLUSIONS
  Patients in our study experienced a variety of visual sensations during cataract surgery under topical anaesthesia. The prevalence of frightening visual sensations is higher than that reported in all previous published studies on the subject and needs to be addressed through targeted interventions.
authors.affiliation: Section of Ophthalmology, Department of Surgery, Aga Khan University, Stadium Road, P,O, Box 3500, Karachi 74800, Pakistan. tanveer.chaudhry@aku.edu.
authors.forename: Tanveer Anjum
authors.initials: TA
authors.lastname: Chaudhry
authors.forename: Amash
authors.initials: A
authors.lastname: Aqil
authors.forename: Kanza
authors.initials: K
authors.lastname: Aziz
authors.forename: Ammar Asrar
authors.initials: AA
authors.lastname: Javed
authors.forename: Mohammad Zain
authors.initials: MZ
authors.lastname: Tauqir
authors.forename: Khabir
authors.initials: K
authors.lastname: Ahmad
mesh_terms: D000368:Aged; D000772:Anesthesia, Local; D002386:Cataract / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003118:Color Perception; D003430:Cross-Sectional Studies; D005239:Fear; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009039:Motion Perception; D010154:Pakistan; D010361:Patients / Q000523:psychology*; D018918:Phacoemulsification / Q000009:adverse effects / Q000523:psychology*; D010775:Photic Stimulation; D011795:Surveys and Questionnaires; D014796:Visual Perception