Measures to improve the comfort of cataract surgery patients: a systematic review and meta-analysis

Authors: Zeng K, Li Q, Xi W, Qiao Y.

Geographical coverage: Iran, Korea, Australia, Turkey, Hungary, United Kingdom, United States of America, Spain, Germany

Sector: Service Delivery, cataract surgery

Sub-sector: Quality of health care services, Quality of clinical care, improving comfort

Equity focus: Not reported

Study population: Patients with cataracts

Review type: Effectiveness review

Quantitative synthesis method: Meta-analysis

Qualitative synthesis method: Not applicable

Background:

Cataracts, a degenerative condition caused by ageing, genetics, radiation, and poor nutrient metabolism, impair vision and can lead to blindness, especially in individuals over 50. They account for approximately 46% of global blindness cases. Surgery, particularly advanced refractive techniques, is the primary treatment. Patients often experience anxiety before surgery due to fears of complications, highlighting the need for tailored preoperative education and comfort-enhancing measures.

Objective:

To identify recent strategies that improve patient comfort during cataract surgery.

Main findings:

The review included 19 randomised controlled trials involving 3,378 cataract surgery patients. Only studies with a Jadad score ≥3 were included; 16 scored ≥4, indicating low risk of bias.

Several studies from Asia—especially China, Korea, Iran, and Turkey—focused on traditional music, massage techniques, and sedatives. European studies from the UK, Germany, Hungary, and Spain explored educational videos, audio therapies, and anaesthetic comparisons. In Oceania, studies from Australia and New Zealand examined preoperative education and anaesthetic methods. The US contributed studies on sedative comparisons and postoperative care.

Eight studies reported on preoperative nursing interventions. Due to variation in anxiety measurement scales, only four studies using the visual analogue scale (VAS) were meta-analysed. Results showed high heterogeneity (I² = 93.5%) but significant reduction in postoperative pain (SMD = −1.19; 95% CI: −1.96 to −0.43; P = 0.002).

Three studies indicated sedatives reduced anxiety and pain, but inconsistent reporting limited meta-analysis. Two oral melatonin studies showed significantly reduced anxiety (SMD = −0.55; 95% CI: −0.95 to −0.15; P = 0.007) with no heterogeneity.

Three studies comparing lidocaine to other anaesthetics showed no significant satisfaction differences (OR = 0.66; 95% CI: 0.31–1.40; P = 0.276). Other interventions lacked data for synthesis. Sensitivity analysis confirmed stability of nursing results. Publication bias was not assessed due to the limited number of studies.

Methodology

Searches were conducted in PubMed, Embase, Web of Science, and supplementary sources such as Google Scholar and print media. Only English-language RCTs published after January 2000 were included.

Inclusion criteria: patients undergoing monocular or binocular cataract surgery; outcomes including anxiety, pain, or satisfaction; interventions in pre- or perioperative periods. Studies were excluded if they involved animals, were non-randomised, postoperative-only, had data errors, or a Jadad score <3.

Two researchers independently screened and extracted data. Disagreements were resolved by discussion. Analyses used Stata 16.0. Standard Mean Differences (SMD) were calculated for continuous outcomes and Odds Ratios (OR) for binary outcomes. Heterogeneity was evaluated using Cochran’s Q and I². A random-effects model was used for high heterogeneity, otherwise a fixed-effects model. Publication bias was not assessed.

Applicability/external validity:

The authors acknowledge limited external applicability due to inconsistent definitions of ‘comfort’ and proxy outcome measures (pain, anxiety, satisfaction). Measurement tool variability, lack of surgical type and duration data, and limited evaluation of certain interventions further reduce generalisability.

Geographic focus:

Iran, Korea, Australia, Turkey, Hungary, United Kingdom, United States of America, Spain, and Germany.

Summary of quality assessment:

Conclusions are presented with medium confidence due to methodological limitations. Searches were not comprehensive, English-only inclusion introduced language bias, and risk-of-bias was not addressed in analysis.