The authors of this e-poster have received travel expense reimbursement from ALCON. The authors have no financial interest in the subject matter of this e-poster. François A Blondeau MD Le Château d’Olonne FRANCE ASCRS San Diego March Rich Wilson Vendee Globe March

Is a patient sedation as mandatory as usually said in cataract surgery ? This study tries to identify what can have been a factor of stress and gives some paths to avoid useless medication and heavy medical environment

Document on next slide has to be given to patient before cataract surgery and patient signature is requested to certify that patient information on surgery is complete. This text is very different of the text to be read on ASCRS web site : The anesthesiologist’s opinion as well as his/her presence, are described as necessary A hospital structure is described as the environment of choice 18 risks are given among them per operative infection with a rate of 1to 3 out of 1000 surgeries Patient is advised : “There is no surgery without risk” and : “Total loss of the eye function or the eye itself may occur”. Some patients give up the surgery.

“If you’re feeling nervous about lens replacement for your cataracts, keep in mind-modern cataract surgery is one of the safest and most effective medical procedures performed today. It helps about 3 million people each year in the U.S. alone, with an overall success rate of 98% or higher. It may also make you feel more confident if you know what you can expect every step of the way- from your initial evaluation to the day of the surgery… Many patients ask their spouse, friend or caregiver to attend their pre- operative appointment, to serve as an extra set of ears to hear the doctor's recommendations and directions.” ASCRS information :

Office based surgery does not induce stress as much as wide hospitalization structures do. Once he has entered the surgery room, he is glad to recognize the voice of the nurse who gave him all the useful recommendations a few days earlier Patient knows the face and the name of each professional he meets at the office

2230 SURGERIES have been performed between November 26, 2006 and February 15, 2011 (39 months) Cataract extraction with IOL : 1801 Intravitreal injections : 429 AVERAGE AGE of PATIENT at TIME of SURGERY 72 ½ FROM 25 ¾ TO 97 ¼ NO INTRACAMERAL INJECTION OF ANTIBIOTIC AT END OF SURGERY

Results : No sedation was the standard procedure for all the patients. As next slide shows more than 100 surgeries were performed in patients with psychiatrics treatments without any change of this treatment. Nearly 150 were performed on patients with medical treatments for depression As next slide shows some where suffering of ALZEIMER, PARKINSON OR EPILEPSY A light sedation has been used for only 2 patients on their demand. No general anesthesia had to be performed on any patient Other associated pathologies are compiled on next slide. Medical Outcome Measurements are Endophthalmitis or TASS rates and Patient Satisfaction. Endophthalmitis rate = 0 Toxic Anterior Segment Syndrome rate = 0

High blood presure1412 CANCERS ( under treatment )37 ARYTHMY304 CHIMIOTHERAPY56 PACEMAKERS61 CANCERS (Remission)258 ANTICOAGULANTS423 previous CHIMIOTHERAPY139 Compensated heart failure109 ANGOR treaments56 HEPATITIS B2 previous vascular diseases245 HEPATITIS C5 VIH3 Asthma. BPCO189 CORTICOTHERAPY78 THORACIC SURGERY3 OXYGENO-THERAPY ≥18H/d13 DIABETES255 INSULIN63 Psychiatry103 PANCREATITE3 ANTIDEPRESSEURS148 ALZHEIMER26 THYROID111 PARKINSON22 EPILEPSY38 PERIPHERIC NEUROPATHY11 RHEUMATOID9 LSA4 HORTON10

A satisfaction questionnaire is given to patients following NF ISO certification requirements This questionnaire is shown on next slide Questions are about 1Quality of reception at the facility 2Waiting delay at the facility 3Quality of information given by surgeon during appointment 4Quality of information given by staff during appointment 5Quality of information given by staff during stay for surgery 6Quality of information about surgery given in written documents 7Quality of care before surgery 8Quality of care after surgery 9Quality of pain care during and after surgery Suggestions Overall satisfaction

Reception at the facility reaches the best performance of quality when written information given to the patient remains a little less efficient that we had hoped. Information given by Surgeon himself, the Nurse or the staff is more efficient. Less satisfaction for waiting delay before surgery – for pupil dilatation - may be explained by stress of patient who did not received sedation but was never a factor during surgery (perception of the quality of pain care is the same than perception of quality of information).

Conclusion This retrospective survey demonstrates that anaesthesiology environment ( or patient sedation most of times ) is useless for cataract surgery procedures in patients even with heavy stabilized pathologies. A good information of patient ( and his closest relatives as suggested on ASCRS web site ) showing the safety and effectiveness of the procedure appears to be very efficient. Analyse shows a little advantage of direct information compared to written. A confident patient may have surgery without any sedation. This is helpful for the care of elderly patients or patients with heavy pathologies ( ASA 3 ). Waiting time during pupil dilatation is an important factor which demands high quality of staff.