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Effectiveness of illustration for alleviating preoperative stress in elderly patients undergoing first-time cataract surgery: A single-blinded quasi-randomized controlled trial

Yi Ching Chiang, Hsiang Ping Wang, Dong Chen Shieh, Hui Ju Lin

Cataract is among the main causes of blindness and visual impairment in the world. According to global statistics, as of October 2019, it is estimated that at least 1 billion people have visual impairment or blindness, excluding refractive errors and presbyopia. The number of individuals with cataracts amounts to 65.2 million, which is much higher than that of people with glaucoma, corneal opacity, diabetic retinopathy, etc. Surgery is currently the only treatment that can save vision in people with cataracts and has been widely used. Most patients can complete surgery under local anesthesia, without hospitalization. Nevertheless, unclear procedures related to surgery and hospitalization, as well as an unfamiliar surgical environment and separation from family members increase the anxiety and stress of elderly patients undergoing cataract surgery, and some consequently even refuse surgical treatment. In addition, it has been reported that the preoperative stress levels of outpatients are higher than that of inpatients, possibly due to insufficient preoperative information: The concise health education guidelines can be a source of preoperative stress. This stress triggers the sympathetic nervous system, resulting in tachycardia, increased blood pressure, and arterial blood vessel contraction, which reduces blood supply to the eye and causes delayed wound healing; it also reduces the function of the immune system and thereby increases the risk of infection. Moreover, high preoperative stress can cause a sudden increase in systolic blood pressure, which causes a transient increase in intraocular pressure; such high intraocular pressure may cause severe complications during surgery.