Determinants of patient expectations and patient satisfaction after uneventful cataract surgery in Gorgan province of Iran: a longitudinal study

Purpose: To study determinants of patients’ expectation of vision improvement after cataract surgery, the discrepancy between expected and actual improvement, and predictors of patients reported outcome (PRO) after taking cataract surgery. Methods: We enrolled patients with visual impairment due to cataract scheduled for surgery between June 2017 and March 2018 at a university-affiliated hospital in Gorgan, Iran. Patients were examined and all completed questionnaires about their visual function and level of difficulties in their daily activities due to their vision, attitude towards surgeon’s competence, self-perceived knowledge about the disease and surgery, and their expectation of improvement in visual function. Actual visual outcomes and patients’ reported satisfaction were assessed at least six weeks after the surgery. We calculated the discrepancy between expected and actual scores of post-surgical visual functions. We developed a multinomial logit model to predict over- and under-expectation of improvement. A generalized estimating equation was developed to predict satisfaction. Results: 88 patients were included in this study. 97% had presenting VA of less than 6/10. The main significant predictors of over-expectation were lower visual acuity (P=0.03), lower knowledge scores (P=0.04), and higher scores of attitude towards surgeon’s competence (P=0.05). Under-expectation was also predicted by lower knowledge (P=0.03) and lower visual acuity (P=0.03). Average score of satisfaction was 8.5 (on 10-point VAS). The main predictors of lower satisfaction were being male (P=0.02), needing corrective glasses after surgery (P=0.005), and over-expectation of the improvements (P=0.001). Conclusion: Over-expectation of visual outcome of cataract surgery is a significant predictor of lower satisfaction, and patients with lower knowledge scores are more likely to have unrealistic (over- or under-) expectations about the effect of surgery. We recommend active engagement of care providers with patients and educational interventions for patients’ need and knowledge. This may help patients develop more realistic expectations especially in those with lower visual acuity at presentation.