ORIGINAL ARTICLES
Parental comprehension following informed consent for pediatric cataract surgery Vasudha Erraguntla, MD*, Irina De la Huerta, MD†, Sunita Vohra, MD‡, Mohamed Abdolell, MSc§, Alex V. Levin, MD储 ABSTRACT ● RÉSUMÉ Objective: To investigate the effectiveness of information transfer by the pediatric cataract surgeon to the parents or guardians of children during the informed-consent process. Design: Prospective observational case series. Participants: Parents of 31 children undergoing cataract surgery. Methods: Parents were enrolled from the clinical practice of 1 pediatric cataract surgeon. Using a checklist developed in consultation with other pediatric cataract surgeons, the surgeon discussed the nature of the disease, the course without surgical intervention, the surgical procedure, the risks and benefits, and the postoperative care. Immediately after the discussion, parents were invited to complete a questionnaire assessing information recall. Analysis of variance and the t test were used to determine associations between questionnaire scores and demographic variables. The surgeon subsequently called parents and discussed again the issues that they had not remembered correctly, as identified by the questionnaire responses. The study and data accumulation were carried out with the approval of the Research Ethics Board at The Hospital for Sick Children, Toronto, Ont. Informed consent for the research was obtained from the parents or legal guardians of the children enrolled in the study. The study adhered to the tenets of the Declaration of Helsinki. Results: Of 31 parents, 18 (58%) overestimated their understanding of the informed-consent discussion. Parents scored well on questions about the nature of the disease and the postoperative follow-up but scored lower on questions regarding surgical risks and outcomes. Parents identified several barriers to understanding, including the large amount of information, stress, and preoccupation with the child. No association was noted between the level of understanding and demographic factors. Conclusions: Parents may overestimate their understanding of informed-consent discussions. Some parents may be overly optimistic about risks and outcomes. The surgeon’s follow-up communication with parents that addressed aspects insufficiently understood during the initial discussion provided a way of improving comprehension. Objet : Investigation sur l’efficacité du transfert de l’information par le chirurgien de la cataracte pédiatrique aux parents et aux gardiens d’enfants dans la procédure de consentement éclairé. Nature : Étude prospective par observation d’une série de cas. Participants : Les parents de 31 enfants subissant une chirurgie de la cataracte. Méthodes : Contexte : Clinique de pratique d’un chirurgien de la cataracte pédiatrique. Procédure : À l’aide d’une liste de vérification mise au point avec des collègues de la chirurgie de cataracte pédiatrique, le chirurgien discute de la nature de la maladie, du traitement sans chirurgie, de la procédure chirurgicale, des risques et bienfaits ainsi que des soins postopératoires. Les parents ont aussitôt été invités à remplir un questionnaire pour évaluer ce qu’ils en ont retenus. L’analyse du test T et de la variance permettent de déterminer les associations entre les résultats du questionnaire et les variantes démographiques. Le chirurgien rappelle les parents pour discuter davantage des questions qu’ils n’auraient pas retenues correctement, selon leurs réponses au questionnaire. Résultats : Parmi les 31 patients, 18 (58 %) avaient surestimé leur compréhension de l’entretien sur le consentement éclairé. Les parents ont bien répondu aux questions sur la nature de la maladie et le suivi postopératoire, mais moins bien sur les risques chirurgicaux et les résultats. Les parents ont identifié plusieurs barrières à la compréhension, y compris l’importante quantité d’informations, le stress et les préoccupations de leur enfant. L’on n’a pas relevé d’association entre le degré de compréhension et les facteurs démographiques. Conclusions : Les parents peuvent surestimer leur compréhension des entretiens sur le consentement éclairé. Certains d’entre eux peuvent se montrer trop optimistes quant aux risques et aux résultats. Pour ce qui est du manque de compréhension des parents sur certains aspects lors du premier entretien, la communication suivante du chirurgien a permis d’améliorer cette compréhension.
Informed consent is a fundamental duty and responsibility that is recognized by virtually every professional medical organization. Patients are expected to reach autonomous decisions about whether to undergo medical procedures.1⬎ Physicians must inform patients about their conditions, proposed treatments, risks and benefits, and
reasonable alternatives. Consent must be voluntary, and patients must demonstrate capacity for consent and understanding of the provided information.2 Authors have challenged the doctrine of informed consent by indicating that patients’ decisions may be based on other factors. Interviews with patients who recovered from esoph-
From the *Department of Ophthalmology, University of Saskatchewan, Saskatoon, Sask.; the †Program in Neuroscience, Harvard Medical School, Boston, Mass.; the ‡Department of Pediatrics, University of Alberta, Edmonton, Alba.; the §Department of Diagnostic Radiology, Dalhousie University, Halifax, N.S.; and the 储Pediatric Ophthalmology and Ocular Genetics, Wills Eye Institute, Philadelphia, Penn.
Can J Ophthalmol 2012;47:107–112
0008-4182/11/$-see front matter © 2012 Published by Elsevier Inc on behalf of the Canadian Ophthalmological Society. doi:10.1016/j.jcjo.2012.01.014
Originally received December 7, 2010. Accepted Feb. 22, 2011 Correspondence to Alex V. Levin, Pediatric Ophthalmology and Ocular Genetics, Wills Eye Institute, 840 Walnut St., Philadelphia PA 19107-5109;
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Informed consent in pediatric cataract surgery—Erraguntla et al. agectomy for cancer suggested an entrustment model based on 6 recurrent themes: belief in surgical cure, enhancement of trust through the referral process, idealization of the specialist surgeon, belief in expertise rather than medical information, resignation to risks involved in treatment, and acceptance of expert recommendation as consent to treatment.3 Substitute decision making is used on behalf of patients who lack the capacity for informed consent.4 Several studies throw light on substitute decision-makers’ understanding and retention of medical information during informed-consent discussions.5,6,7 To our knowledge, no study has been conducted regarding pediatric cataract surgery. Our aim was to assess the transfer of information from physician to substitute decision makers. We measured comprehension by using a post–informed-consent discussion questionnaire.
METHODS The subjects of this prospective study were the parents or legal guardians in the ophthalmology clinics of the senior author (A.V.L.) at The Hospital for Sick Children in Toronto. The study’s subjects were required to be fluent in English and able to attend and listen to informed-consent discussions. They provided written consent to participate. We enrolled all children having cataract surgery for any cataract, at any age, who had not undergone previous eye surgery. Children undergoing emergency surgery (⬍ 24 hours) were excluded. Substitute decision makers were excluded if they were eye care or health care professionals (e.g., physicians, nurses, optometrists, opticians); were younger than 18 years of age; were unable to read the questionnaire without assistance from another adult; were hearing impaired; were known to require assistance in decision making; refused; or were too distraught to participate. When patients were identified as needing cataract surgery, informed-consent discussions were conducted by A.V.L. A convenience sample size was based on available patients during the enrolment period (October 2003 through January 2006). An eye model was used to demonstrate relevant anatomy. A checklist (Appendix A) was used to ensure that all relevant points were covered. Checklist items were developed through the consensus of 5 expert pediatric cataract surgeons along with A.V.L. Attempts were made to structure conversations in the same order as noted on the checklist so as to provide consistency. Scripting was not used otherwise, and the discussion was sculpted to fit the families’ needs. No supplemental written material was given prior to the administration of the study’s questionnaire. Immediately after the consent discussion the decision makers had the opportunity to ask questions. They were then asked by a research assistant (or the surgeon, if after hours) to complete a knowledge test. It was explained that the purpose of this study was to ensure that the decision maker had understood the information. Parent couples
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Table 1—Grading of answers to questionnaire for the purpose of t test correlations Collapsed into correct Correct answer Wrote “wasn’t discussed” correctly “No answer” and was not discussed “Don’t know” and was not discussed
Collapsed into incorrect Incorrect answer, whether discussed or not Wrote “wasn’t discussed” incorrectly “No answer” and was discussed “Don’t know” and was discussed
were allowed to consult with each other in responding to the questionnaire, provided both had been present for the consent discussion. They were informed that the surgeon (A.V.L.) would review their responses and call to clarify any areas in which understanding was incorrect or incomplete. Subjects were warned that they might experience increased anxiety while filling out the questionnaire and were offered another discussion with the surgeon or consultation with the ophthalmology social worker. Questionnaires were not anonymous. A section was included to ascertain data about the study’s subjects (e.g., relationship to patient, education level) and their perceptions of their comprehension. Questionnaires were color coded to indicate whether the patients were to undergo cataract extraction with or without posterior chamber intraocular lens (PCIOL) implantation because this knowledge was needed in evaluating questionnaire responses. Aphakic children were to be corrected postoperatively with contact lenses or with glasses if contact lenses failed. The questionnaire was piloted with the parents of 10 children who had had cataract surgery the previous year. They were asked to complete the questionnaire and comment on its readability, format, and clarity. They placed their responses in sealed envelopes without identifiers so as to maintain anonymity. All suggestions were minor. Changes were made in accordance with the feedback. Responses to the pilot questionnaire were not included in the study results or analysis. Each completed questionnaire was scored by the surgeon (A.V.L.), usually within 24 hours of the visit. All subjects who scored less than 100% were called by the surgeon within 1 week of the informed-consent discussion and no fewer than 3 days prior to surgery so as to clarify areas incompletely understood. All subjects were also given the opportunity to meet the surgeon in person again. No subject made this request. Because the questionnaire was a research tool, it was not included in health records, although copies of the informed consent to participate were included. Answers to each questionnaire item were graded and collapsed into 2 categories: correct or incorrect (Table 1). Data were analyzed by calculating a test score in which each correct answer was graded 1 point. We performed t tests to determine differences in test scores among various demographic variables. Univariate analysis of variance was
Informed consent in pediatric cataract surgery—Erraguntla et al. Table 2—Reason for cataract surgery
Table 4 —Perception of the risks of cataract surgery Respondents (%)
Agree Cataract is a cloudiness of the natural lens of the eye The child’s eye cannot see well due to cataract The child will lose vision without surgery The child can undergo surgery at any age and still regain the same amount of vision
Disagree
Respondents (%)
Don’t know
100
0
0
100
0
0
83.9
9.7
6.5
6.5
80.7
12.9
used to study the relationships between scores and all variables; p ⬍ 0.05 was considered statistically significant.
RESULTS We recruited 31 patients (mean age, 4.26 years). Of those patients, 17 underwent PCIOL implantation. Both parents were present for the discussion and completed the questionnaire together in 45% of cases. The mother completed the questionnaire alone in 32%. The highest education levels of parents were as follows: completed grade school, 32.3%; trade school or 2-year college, 35.5%; university, 9%. All parents claimed to understand at least 75% of the information, and 55% claimed to understand all of the information provided by the surgeon. Only 10% of questionnaires were correct in their entirety. No association was found between test scores and levels of self-reported understanding (p ⫽ 0.477). Most parents (84% to 100%) recognized the definition of and the natural progression of cataracts if they remained untreated (Table 2). In the questionnaires, 25 (81%) correctly stated that the potential for visual recovery is age dependent. All parents correctly identified whether surgery was to be done unilaterally or bilaterally. For children with bilateral cataracts (n ⫽ 12), all parents recalled that each eye would be operated on during different days. All parents recognized that the entire lens of the eye, but not the eyeball itself, would be removed (Table 3). Of the parents, 19% did not recall any risks (Table 4). Of 31 questionnaires, 9 (29%) indicated that parents did not know that a complication of cataract surgery could be blindness, and 4 parents (13%) did not know that reoperation could be necessary. When asked specifically, 27 parents (87%) agreed that glaucoma is the biggest risk in cataract surgery. The questionnaire showed that 23% of parents believed that after cataract surgery, the operated eye would be like a
There are no risks in undergoing cataract surgery The biggest risk of cataract surgery is glaucoma My child may need more than one surgery for the eye with cataract Complications of surgery may lead to blindness in the operated eye The cataract may regrow after the surgery
Agree
Disagree
Don’t know
19.4
77.4
3.2
87.1
9.7
3.2
80.6
6.5
12.9
64.5
6.5
29.0
0
74.2
25.8
normal eye (Table 5). Additionally, 19% thought their children did not need follow-up after surgery. No parents expected guaranteed normal vision (Table 5), but 90% correctly indicated that their children might need glasses, and 93% stated that their children’s eyes might require patching. And 78% of parents agreed that their children would need monitoring for glaucoma (Table 6). Of the parents, 19% reported that the large amount of information provided interfered with their ability to understand fully the informed-consent discussion. Preoccupation with their children and stress were identified by 19% as barriers to understanding. No association was found between test scores and demographic factors, including relationship to child (p ⫽ 0.800); educational background (p ⫽ 0.096); and whether the subject was a first-born child (p ⫽ 0.824).
DISCUSSION Informed consent is a fundamental tenet of surgical practice. The success of informed consent depends on the competency of the person receiving the information and on clear disclosure about the diagnosis, natural disease course, possible courses of treatment, risks and benefits, and alternatives.8 Clear transmission of information is but one part of the equation; understanding by the recipient is also critical. Our results showed that parents of children undergoing cataract surgery may have difficulty in assimilating the information provided to them during the informed-consent discussion. Of the parents, 19% found that the amount of information presented in a single session was excessive. For 35.5% of the parents, other obstacles to understanding the
Table 5—Expectations of cataract surgery outcomes Respondents (%)
Table 3—Surgical procedure Agree (%) The entire lens of the eye will be removed The eyeball will be taken out and reinserted after the cataract is removed Stitches in the eyeball will need to be removed
100 0 0
After cataract surgery, the operated eye will be like a normal eye My child will not need further followup after surgery My child is guaranteed to have normal vision after the surgery
Agree
Disagree
Don’t know
22.6
67.7
9.7
19.4
70.9
9.7
0
93.5
6.5
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Informed consent in pediatric cataract surgery—Erraguntla et al. Table 6 —Follow-up required after cataract surgery Respondents (%)
My child may need glasses after the surgery* My child may need patching treatment of the good eye after surgery* My child will need to be monitored for glaucoma for the rest of his/her life
Agree
Disagree
Don’t know
89.7
3.4
6.9
92.9
3.6
3.6
77.4
16.1
6.5
*Children who would not benefit from glasses or patching postoperatively were not included in the analysis of this question.
informed-consent discussion were stress and preoccupation with their children, and 32% had further questions after completing the questionnaire. A majority of parents overestimated their levels of understanding. Likewise, studies of informed consent for adult cataract surgery found that patients reported high levels of satisfaction with the informed-consent explanation, but their retention rate ranged from only 37% to 61%.9,10 Of 31 parents, 26 (84%) correctly answered questions about the natural history of cataracts. The fact that visual development is age dependent was poorly understood, however; 16% indicated that vision is fully developed by the age of 2 years, and 6 (19%) either did not know or thought that their child could undergo cataract surgery at any age and still regain the same amount of sight. The postnatal development of vision may be the most medically complex and abstract topic covered in informed-consent discussions of pediatric cataract surgery. Susman and coworkers showed that, in young adults, abstract concepts have the lowest retention rates of all topics covered in informed-consent discussions.11 Potential complications in cataract surgery were poorly recalled: 23% either did not know or thought that no complications are involved in cataract surgery. When asked about a specific risk mentioned in informed-consent discussions (glaucoma), only 13% denied knowledge. The risk for blindness had the lowest recall of all the surgery risks: 29% did not know, and 6% denied that surgery could lead to sight loss. Additionally, 6 parents (19%) did not know that or denied that their children might require reoperation. Patient and parent/guardian recall of the possible risks of a surgical procedure has been noted by previous studies to be low. In a questionnaire given to parents of children undergoing urologic procedures, 22% did not recall that risks of surgery were discussed.12 In a study of 181 parents who consented to their children’s participation in a neonatal randomized control trial, 39.2% perceived no risk.13 Of adult patients scheduled for cataract surgery, 76% believed that there was no risk.14 Such findings may be explained by the presence of cognitive dissonance.15 Cognitive dissonance occurs when 2 simultaneous thoughts conflict (e.g., the information about risks conflicts with belief that surgery is beneficial). When information is received sequentially, people prefer
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information that is favourable to their existing decision.15 Having understood their children needed cataract surgery, the parents in our study were exposed to information about risk that was likely to induce mental stress, particularly given parental perceptions of the importance of childhood vision. To avoid cognitive dissonance, parents may have devalued information about adverse events. Cognitive dissonance has been used to explain low patient recall of risks in other studies of informed consent,14,16 although this analysis may not hold true for all clinical situations. For example, a study of patients undergoing carotid endarterectomy found that the patients perceived the risk of the procedure as being threefold to fivefold higher than was explained by the surgeon and that the magnitude of expected risk correlated positively with the expectations of the benefits of the surgery.17 Further study is needed to ascertain the extent to which the acute or life-threatening nature of a disease and the invasiveness of the procedure influence patients’ perceptions of risks. The parents in our study showed good recall of the expected postoperative care; 29 (94%) understood that their children were not guaranteed to have normal uncorrected vision after the surgery, and 28 acknowledged that their children might need glasses and patching of the unaffected eye. Given these results, it surprised us to find that 7 parents (23%) believed the operated eye would be “like a normal eye.” It is possible that some of the parents who acknowledged the risk for subnormal vision believed that the risk was small and that their children would not experience it. Alternatively, it may be that the parents in our study thought only of the gross appearance of their children’s eyes when indicating that it would be “like a normal eye” postoperatively. Overall, our study highlighted several aspects of informed consent that parents have difficulty recalling correctly. They include complex medical information, such as the age-dependent development of vision, the risks of surgery, and the expected outcomes. Our results should, however, be regarded in the light of several study limitations. Although our study was prospective, our numbers were small. Only 1 surgeon was involved, so results may be more reflective of the surgeon’s own style or ability to present the information during the informed-consent discussion. Given the experience of this surgeon, with both informed consent and pediatric cataract surgery (more than 1000 cases), and given the similarity of our results to those in the literature, we believe this is unlikely. The language used in the informed-consent discussion may have posed barriers to understanding. A previous study found that sample texts provided by ethics review boards for informed consent were, on average, aimed above the grade 10 level,18 when the stated aim was to provide material at grade 6 to 8 reading levels. Although the surgeon in our study attempted to attain this language level, we did not evaluate whether this goal was achieved. Parents and patients were given the opportunity, and were encouraged at the time of
Informed consent in pediatric cataract surgery—Erraguntla et al. the discussion and before the questionnaire was presented, to ask questions for clarification. Barriers to such interaction included the parents’ desire not to take too much of the doctor’s time, discomfort or embarrassment about asking questions, anxiety related to their children’s conditions, and feeling overwhelmed by the amount of information presented. Previous studies of informed consent in both adults and children have shown that recall decreases with increasing amounts of information presented.11,19 Other studies of informed consent in pediatrics indicate that most substitute decision makers prefer to break up the informed-consent discussion into at least 2 sessions so to facilitate retention.20,21 However, only 19% of parents in our study thought the quantity of information was excessive. The process of informed consent in a surgical practice usually ends when the patient or the substitute decision maker signs a consent form, with no further checks that the signer understood and retained the information presented. In our study, the majority of parents overestimated their understanding. By virtue of this study protocol, we were pleased to have a system of assessing parental understanding. The surgeon subsequently communicated with each parent by phone to address questions that the parents had answered incorrectly. Perhaps this process, although somewhat time consuming, warrants further examination, in particular to assess whether it ultimately does improve comprehension. Procedure-specific information forms given at the time of consent discussions can improve later recall,4,8 but our specific intervention of postdiscussion follow-up calls to address specifically information known to be incorrectly understood might better ensure a higher level of informed consent. Any intervention that can correct parental misconceptions about surgical risks and expected results might also improve satisfaction with operative outcomes.
Disclosures: The study was supported in part by Brandan’s Eye Research Fund and the Foerderer Fund. The funding organizations had no role in design and conduct of this research. The authors have no proprietary or commercial interest in any materials discussed in this article.
REFERENCES 1. Beauchamp TL, Childress JF. Principles of Biomedical Ethics, 4th ed. New York: Oxford University Press, 1994,142–57. 2. CPSO Policy Statement, College of Physicians and Surgeons of Ontario, policy 1-01. Available at www.cpso.on.ca/Policies/consent.htm. Accessed July 29, 2008. 3. McKneally MF, Martin DK. An entrustment model of consent for surgical treatment of life-threatening illness: Perspective of patients requiring esophagectomy. J Thorac Cardiovasc Surg. 2000;120:264-9 4. Lazar NM, Greiner GG, Robertson G, Singer PA. Bioethics for clinicians: 5. Substitute decision-making. CMAJ. 1996;155:1435-7. 5. Eustis S, Smith DR. Parental understanding of strabismus. J Pediatr Ophthalmol Strabismus. 1987;24:232-6. 6. Mason SA, Allmark PJ for the Euricon Study Group. Obtaining informed consent to neonatal randomised controlled trials: Interviews with parents and clinicians in the Euricon study. Lancet. 2000;356: 2045-51. 7. Kodish E, Eder M, Noll RB, et al. Communication of randomization in childhood leukemia trials. JAMA. 2004;291:470-5. 8. Jones JW, McCullough LB, Richman BW. A comprehensive primer of surgical informed consent. Surg Clin N Am. 2007;87:903-18. 9. Morgan LW, Schwab IR. Informed consent in senile cataract extraction. Arch Ophthalmol. 1986;104:42-5. 10. Scanlan D, Siddiqui F, Perry G, Hutnik CML. Informed consent for cataract surgery: What patients do and do not understand. J Cataract Refract Surg. 2003;29:1904-12. 11. Susman EJ, Dorn LD, Fletcher JC. Participation in biomedical research: The consent process as viewed by children, adolescents, young adults, and physicians. J Pediatr. 1992;121:547-52. 12. Steven M, Broadis E, Carachi R, Brindley N. Sign on the dotted line: Parental consent. Pediatr Surg Int. 2008;24:847-9. 13. Deber RB, Kraetschmer N, Irvine J. What role do patients wish to play in treatment decision making? Arch Intern Med. 1996;156:1414-20. 14. Kiss CG, Richter-Mueksch S, Stifter E, et al. Informed consent and decision making by cataract patients. Arch Ophthalmol. 2004;122: 94-8. 15. Jonas E, Schultz Hardt S, Frey D, Thelen N. Confirmation bias in sequential information search after preliminary decisions: An expansion of dissonance theoretical research on selective exposure information. J Pers Soc Psychol. 2001;80:557-71. 16. Wagener JJ, Taylor SE. What else could I have done? Patients’ responses to failed treatment decisions. Health Psychol. 1986;5:481-96. 17. Lloyd A, Hayes P, Bell PRF, Naylor AR. The role of risk and benefit perception in informed consent for surgery. Med Decis Making. 2001; 21;141. 18. Paasche-Orlow MK, Taylor HA, Brancati FL. Readability standards for informed-consent forms as compared with actual readability. N Engl J Med. 2003;348:721-6. 19. McGuire LC. Remembering what the doctor said: Organization and older adults’ memory for medical information. Exp Aging Res. 1996;22: 403-28. 20. Eder ML, Yamokoski AD, Wittmann PW, Kodish ED. Improving informed consent: suggestions from parents of children with leukemia. Pediatrics. 2007;119:e849-59. 21. Flory J. Ezekiel E. Interventions to improve research participants’ understanding in informed consent for research: A systematic review. JAMA. 2004;292:1593-601.
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Informed consent in pediatric cataract surgery—Erraguntla et al. APPENDIX: A CHECKLIST FOR THE SURGEON Definition of cataract A cataract is an opacity in the lens of the eye. The lens is located behind the pupil. Cataract exists in one eye or both eyes. Possible causes of this cataract. Presence or absence of systemic implications (e.g., further testing if indicated) Presence or absence of genetic implications (e.g., recurrence risk, need to examine family members, to examine future offspring in first 2 weeks of life) Need for the surgery Indications for surgery (to clear visual axis to restore vision and allow visual development) Urgency for the surgery (relative to age) Degree of impairment with vs without surgery Need for surgery in one eye or both eyes Surgical procedure Preoperative management issues (e.g., patching) Intraoperative procedure (lens removal with or without intraocular lens implantation [IOL]; with or without primary posterior capsulotomy; nature of incisions; absorbable sutures) Options: IOL vs aphakic glasses versus contact lenses. If surgery needed for both eyes, to be done on separate days Anaesthetic risks (in terms of common life events: less than risk of same adverse events happening in car driving to hospital) Death Brain injury Other adverse reactions Special risks related to underlying medical conditions (where applicable) Surgical risks and how those complications are managed should they occur: Infection (rare) Bleeding (not uncommon but usually self-resolving)
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Cosmetic changes (pupil, lid) Retinal detachment (rare) Glaucoma (up to 30%, depending on nature of cataract and eye) Loss of vision/blindness (very rare) Loss of lens matter into the vitreous, possibly requiring future surgery (rare) Inability to place IOL in the eye (e.g., loss of posterior capsule [if not planning posterior capsulotomy]) Suboptimal power IOL power/need for glasses ⫹ IOL Unknown lifetime risk in IOL Reoperation (uncommon) Postoperative iritis (especially with IOL) to be treated with topical steroids (potentially as frequent as every hour) with or without oral steroids Cataract cannot regrow but scar tissue or some cells can Postoperative care Regular application of eye drops Application of shield or patch Postoperative follow-up schedule Glasses as needed for residual refractive error Where indicated, contact lens fitting schedule, outline of procedure, and costs Possible need for amblyopia treatment, patching (where applicable) Possible need for treatment for strabismus Prognosis If unilateral, normal function with just good eye Possible irreversible amblyopia The eye will never be normal and even if it sees 20/20 will still need help to see up close Potential for improved vision in the affected eye with versus without surgery
