Risk Communication in Cataract Surgery

Author Block: Diana Lucia Martinez 1, Iqbal Ike Ahmed 1, Matthew B. Schlenker 2. 1Prism Eye
Institute, 2Trilium Health Partners.
 

Author Disclosure Block:   D.L. Martinez:  None.  I. Ahmed:   Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Aequus: C - Ace Vision: C - Aerie Pharmaceuticals: C, R - Akorn: C - Alcon: C,S,R - Allergan: C,S,R - Aquea Health, Inc: C -  ArcScan: C - Avellino Lab USA, Inc: C - Avisi: C - Bausch Health: C, Beaver Visitec: C - Beyeonics: C -Bionode: C, R - Carl Zeiss Meditec: C,S - Centricity Vision, Inc: C - CorNeat Vision: C - Custom Surgical: C - Elios Vision: C - ElutiMed: C - Equinox: C, eyeFlow, Inc: C - Exhaura Limited: C - Genentech: C - Glaukos: C, R - Gore: C - Heine: C, S - Heru: C - Iantrek: C - InjectSense: C - Iridex: C - iCare: R - iStar: C - Ivantis: C, R, Johnson & Johnson Vision: C, S, R - Labtician Thea: C -  LayerBio: C - Leica Microsystems: C - Life Long Vision: C - Long Bridge Medical, Inc: C - MicroOptx: C - MST Surgical: C, S - Myra Vision: C, New World Medical: C, R -  NovaEye: C - Ocular Instruments: C - Ocular Therapeutix: C - Oculo: C - Oculus Surgical: C - Omega Ophthalmics: C - PolyActiva: C - PulseMedica: C, Radiance Therapeutics, Inc: C - Ripple Therapeutics: C - Sanoculis: C - Santen: C, R - Shifamed, LLC: C - Sight Sciences: C - Smartlens, Inc: C - Stroma: C - Thea Pharma: C - ViaLase: C, Visus Therapeutics: C - Vizzario: C - VSY Biotechnology: C - Zilia, Inc: C. Any direct financial payments including receipt of honoraria; Description of relationship(s); C: Consulting Fees, S: Speakers Honoraria, R: Research Grant/Support.  M.B. Schlenker:   Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Alcon: C, S - Allergan: C, S - Aequus: C,S - Johnson & Johnson Vision: S - Labtician Théa: S - Light Matter Interaction Inc: C - Santen: C. Any direct financial payments including receipt of honoraria; Description of relationship(s); C: Consulting Fees, S: Speakers Honoraria.

Abstract Body: 

Purpose: Risk communication is an integral aspect of shared decision‐making and
evidence‐based patient choice. There is currently no standardized or recommended way of
communicating the risks and benefits of cataract surgery to patients, as it is usually up to each
ophthalmologist’s discretion. This study aims to investigate whether the way this information is
presented influences patients’ perception of how risky surgery will be. 

Study Design: Two‐arm parallel randomized experimental design. 

Methods: Patients referred for cataract surgery who
have not yet made their decision to undergo surgery were considered for this study. Patients were
randomly assigned to one of two study groups (positive or negative framing). Then, a brief
questionnaire including sociodemographic variables (age, sex, education), prior cataract surgery
knowledge, and visual satisfaction was administered. According to their assigned study group, the
risks of cataract surgery were then communicated to patients using either positive framing (99%
chance of no side effects) or negative framing (1% chance of side effects). Patients then rated their
perceived risk of experiencing surgical complications on a scale ranging from 1 (not at all likely) to 6
(very likely). The responses were analyzed to identify significant differences in patient scores among
study groups as well as other potential drivers of change in scores. 

Results: This study included a total of 60 patients, 30 in each study group, majority of patients were female (70% in the positive framing group and 57% in the negative framing group), and the mean age was 70±10 years and 72±9
years, respectively. Median (IQR) risk perception was 2 (1‐2) in the positive framing group and 3 (2‐
3) in the negative framing group. Statistically significant difference was found between the groups
(p=.0007). There was no significant difference in risk perception by sex per study group (p=.24 and
p=.17), education (p=.71 and p=.26), visual satisfaction (p=.8 and p=.45), and prior knowledge (p=.39
and p=.2). Age did not significantly predict risk perception (r 2= .0004 and p=.88). No correlation was
observed between risk perception and waiting time between referral and cataract consultation (r
2=.008 and p=.5) 

Conclusions: Patients who received positive framing reported lower risk scores
for cataract surgery than patients who received negative framing. Sociodemographic factors were
not identified as significant drivers of change in patients’ perceived risk. A larger sample size is
needed to further investigate.