Fear of Cataract Surgery and Vision Loss: The Effects of Health Literacy and Patient Comprehension at an Academic Hospital-Based Eye Clinic.

Purpose: This qualitative study assessed the relationship between health literacy and perceptions surrounding fear of cataract surgery and fear of vision loss in patients presenting to a Midwestern, urban, safety-net hospital-based clinic setting. Patients and Methods: Forty-two patients were recruited from the Hoxworth Eye Clinic at the University of Cincinnati Medical Center. The inclusion criteria were as follows: established patient at the clinic, age 50 or older, diagnosis of cataract by ICD-10 and/or physical exam, and no history of prior cataract surgery. Each patient completed a survey of demographic information and questions targeting their understanding and attitudes surrounding cataract pathology and treatment, and the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF), a validated 7-item word recognition test assessing patient health literacy. Two-tailed t-tests assuming equal variances and chi-squared tests conducted in Excel were used in statistical analyses. Results: In our cohort (n = 42), there was no association between score on the REALM-SF and fear of cataract surgery (p = 0.87), but there was a significant association between fear of cataract surgery and belief that cataract surgery would improve vision (p = 0.03). Conversely, there was no significant association between fear of vision loss and belief that cataract surgery would improve vision (p = 0.92). The factors underlying these findings may be further clarified when attitudes surrounding cataract surgery and vision are categorized based upon best corrected visual acuity (BCVA). Patients with BCVA worse than 20/40 in only one eye fear cataract surgery more than patients with BCVA more than 20/40. Conclusion: In our patient population, neither health literacy nor understanding of cataract pathology was associated with fear of cataract surgery. However, given patients who feared cataract surgery were less likely to believe cataract surgery would improve vision, clarifying goals of surgery and addressing patient fears should be prioritized. Interestingly, this may be more important at earlier stages of non-visually significant cataracts for patients with good vision.