Study confirms “second eye” effect in cataract surgery

Many authors have described a “second eye” effect in cataract surgery in which patients report a more unpleasant experience with their second eye surgery. This study adds support to this observation, finding significant differences in categories, such as pain level and perceived duration of surgery.    

The authors administered questionnaires to 280 patients during the immediate postoperative period following cataract surgery. Patients whose surgeries took longer than 30 minutes were excluded from the study. 

Before surgery on their second eye, patients reported significantly less anxiety and significantly higher expectations for the visual outcome with their second eye. 

Of 280 patients surveyed, 45.4% said that surgery on their second eye was a generally less pleasant experience compared to 13.5% who listed the first eye. The remainder felt the experience was similar. After a patient selected which surgery was the worse experience, subsequent questions asked about pain levels, perceived duration of surgery, preoperative anxiety levels and visual expectations for surgery.   

The authors suggest several possible explanations for their findings, which are in line with prior studies on the topic. Patients are more anxious prior to the first surgery and may have greater expectations of pain. This could result in a comparatively worse experience with their second eye after a relatively painless first surgery. 

The patients in this study received midazolam and fentanyl during their surgeries. Since the questionnaire was administered immediately after surgery, they may have been amnestic to any discomfort experienced during their first eye surgery. 

While patients reported less anxiety going into their second surgery, their expected visual outcome was higher than before the first surgery. The may create an “expectations gap” between perceived and actual visual improvement. This is especially true when the second eye is a milder cataract than the first. This data is useful to surgeons and surgical coordinators as they prepare patients for a unique experience with each eye surgery they undergo.