University of Cincinnati researchers find fear of vision loss may be deterring patients from cataract surgery

The research team surveyed 42 patients 50 years of age and older at Hoxworth Eye Clinic. Image credit: AdobeStock/ronnarong

Researchers from the University of Cincinnati (UC) found that fear of vision loss may be deterring some patients from undergoing cataract surgery deemed necessary to reverse blindness or vision loss.¹ The study, published in The Journal of Clinical Ophthalmology, was led by Lisa Kelly, MD, a Taylor Asbury-endowed professor-educator and director of medical student education in the Department of Ophthalmology at the UC College of Medicine, according to a UC News article.

The research team surveyed 42 patients 50 years of age and older at Hoxworth Eye Clinic, the training site for UC’s ophthalmology residents in order to explore the possible link between health literacy and fear surrounding cataract surgery.¹ Hoxworth Eye Clinic is a tertiary hospital-based eye clinic that largely serves Cincinnati’s uninsured and underinsured population, according to the researchers. A majority (60%) of participants reported a yearly income below $50,000.²

Inclusion criteria for the study included a diagnosis of cataract by ICD-10 and/or physical exam and no history of prior cataract surgery. Patients completed both a survey targeting their understanding of and attitudes regarding cataract pathology and treatment and their fear of the surgery and vision loss, and a Rapid Estimate of Adult Literacy in Medicine – Short Form (REALM-SF). An understanding of cataract pathology or of broader health literacy was defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”²

“We hypothesized that patients with lower health literacy would fear surgery more, especially the risk of vision loss,” said Samantha Hu, corresponding study author and fourth-year medical student, in the article. “But our findings didn’t support that.”

Of participants surveyed, 36% reported a fear of cataract surgery, with more than half of those specifically feared it would lead to vision loss.^1,2 Researchers found no correlation between this fear and a patient’s health literacy level, with 20% of participants scoring less than 7 points on the REALM-SF, thus being considered “lower health literacy.”²

Instead, the study found that fear of cataract surgery may instead correlate with the quality of the patient’s vision. “In our study, patients with both eyes worse than 20/40, a somewhat arbitrary threshold utilized to indicate patients may have visually impairing cataracts, did not fear cataract surgery and believed it could improve their vision,” study authors stated.² “In contrast, patients with 1 eye worse than 20/40 overwhelmingly believed that cataract surgery improves vision; however, this same cohort had higher rates of fear of vision loss and fear of cataract surgery.”

“We found patients who would benefit from surgery reasonably understood the procedure after we educated them,” Kelly said in the article. “But even with clear explanations, sometimes their fear persisted.”

Hu also noted that providing more information may not lead to reducing fear in patients. “Overloading patients with data doesn’t necessarily ease their concerns,” she said in the article.

Instead, Hu and Kelly underscored the importance of open communication with patients. “It’s a reminder that our patients are people with real fears. Our role is to partner with them in their health care,” Kelly said in the article.

Study authors stated that further research should include diverse environments and populations, including those in non-safety net hospitals, patients with English as their second language, insured patients, rural areas, other geographic regions outside of the Midwest, and countries other than the United States. Prospective studies with a cohort of patients with cataracts having their level of fear recorded prior to and after a counseling session for questions and concerns may also be beneficial to learn what value education plays in subduing fears.²

References:

1. Burgasser M. UC study finds vision loss fear may keep some from having cataract surgery. UC News. April 23, 2025. Accessed April 23, 2025. https://www.uc.edu/news/articles/2025/04/uc-study--fear-may-deter-patients-from-cataract-surgery.html

2. Hu S, Wey S, Yano RA, Kelly LD. Fear of cataract surgery and vision loss: The effects of health literacy and patient comprehension at an academic hospital-based eye clinic. Clin Ophthalmol. 2025;19. doi:10.2147/OPTH.S490630