Two interesting articles

• The first article discusses a qualitative study of ophthalmologists’ experiences, along with related recommendations for patient safety.
• For the second article, twelve patients with monocular vision were interviewed, all of whom had undergone glaucoma surgery on their good eye.

About Surgery on the Seeing Eye in Monocular Animals

Performing surgery on the functioning eye of patients who see with only one eye (hereinafter referred to as “monocular patients”) is a matter requiring great care and attention from the ophthalmic care team. After all, complications in such cases can lead to catastrophic vision loss. At present, there is no evidence that surgeons provide special care when treating these patients. Furthermore, there are no specific guidelines on how to manage these patients. Although eye surgery generally carries a low risk of complications, vision-threatening complications such as infections and postoperative bleeding cannot be ruled out. Monocular patients experience significant psychological stress during surgery on their seeing eye. They are very afraid of going blind if complications arise. Furthermore, the surgical team also experiences significant stress during such procedures. The study aims to investigate the experiences of eye surgeons during surgical procedures on patients with only one eye. How is current practice perceived by the eye surgeon and the patient? And what can be improved? The first article is written from the eye surgeon’s point of view, and the second from the perspective of the (monocular) patient.

Study 1: Five Key Themes

The first article describes the experiences and insights of ten eye surgeons working in ophthalmology departments at eye hospitals and general hospitals in various countries. This was done through in-depth, semistructured interviews, which were recorded and transcribed. The results were then analyzed thematically to identify key themes.

The first article identified five key themes related to the surgeons’ experiences and perceptions of these surgical procedures:

1) There are differences in approaches to obtaining consent for surgery,
2) Strategies to reduce surgical risks,
3) Better training for ophthalmologists,
4) The importance of a surgical mentor for the ophthalmic surgeon,
5) The emotional impact of surgeries that went wrong.

Recommendations for improving the patient and surgeon experience primarily focused on better recognition and understanding of the issues closely associated with these surgical procedures. Here are a few of the many comments related to the five key themes that emerged from the interviews with eye surgeons:

1. Consent for surgery: Should the eye surgeon explain all the risks, or would that just scare the patients?
2. Strategies to reduce surgical risks:
   – Better surgical instruments.
   – As an ophthalmologist, prepare yourself thoroughly—for example, by visualizing everything you need to do beforehand.
3. Better training for ophthalmologists: In the United Kingdom, the training program is now much shorter than it was twenty years ago.
4. Assign a surgical mentor to the eye surgeon and have the surgery performed by two experienced surgeons and a skilled surgical team with extensive experience.
5. Emotional impact on the surgeon and the patient following surgeries that went wrong. It is sometimes said that there can be two victims: the patient and the ophthalmologist.

Study 2: Will I still be able to see when the bandage comes off?

The second article** is titled “Will I Still Be Able to See When the Bandage Comes Off?” and is written from the perspective of a patient with only one eye who is about to undergo surgery on their good eye. Three key themes emerged here: (1) the emotional impact of the surgical procedure, (2) the burden of vision loss in the functioning eye, and (3) how patients cope with eye surgery.

Here are a few of the many comments regarding the three key themes that emerged from the interviews with patients:

1. Emotional impact of the surgery:
   – it really affects the patients;
   – they’re all just really scared;
   – a lot of fear of a bad outcome;
   – will I still recognize myself when the bandages come off?
   – a lot of uncertainty;
   – other people’s bad experiences cause additional anxiety.
2. The Impact of Vision Loss: If you go blind, your quality of life changes dramatically: driving, work, dependence on others, etc.
3. To get through the surgery, patients benefit greatly from:
   – Family and friends;
   – but trust in the eye surgeon also plays a key role in how patients cope with the surgery;
   – people find candid information about what might happen to be helpful;
   – optimism also makes the surgery more bearable; knowing that you’ve done everything you can and made the right decision.

Conclusions

Editor Huub Scholten: The outcomes of surgical procedures for people with monocular vision can be improved in several ways, including (1) establishing targeted training grants in this field, (2) ensuring that patients are less anxious before surgery, and (3) improving the availability of supportive care. The authors have demonstrated that there are issues unique to eye surgery for people with monocular vision and that there is a need in the United Kingdom for guidelines on the care of these high-risk patients. OOG in OOG will investigate further whether such guidelines exist in the Netherlands.

Sources

* Jones, Taylor, Sii, Masood, Crabb & Shah, (2019). The Only Eye Study (OnES): A qualitative study of surgeons’ experiences with only-eye surgery and recommendations for patient safety.

** Jones, Taylor, Sii, Masood, Crabb & Shah, (2020). Only Eye Study 2 (OnES 2): “Am I going to be able to see when the patch comes off?” A qualitative study of patient experiences with high-stakes only-eye surgery.