Expectations and outcomes in cataract surgery

Objectives: To document patients' preoperative expectations for postoperative outcomes. To measure the relative contribution of patient understanding, expectations, outcome, and expectation-outcome discrepancy in determining patient satisfaction. Methods: One hundred twenty-one patients were surveyed just before and 1 month after cataract surgery regarding their understanding of the procedure, satisfaction with their vision, and both current and expected visual function for each of the items on the Visual Function Index (VF-14). Results: Sixty percent of patients expected to achieve a perfect VF-14 score. The average expected VF-14 score was 96.1, compared with an achieved VF-14 score of just 89.8. The most unrealistic expectations involved driving at night, reading small print, and doing fine handiwork. Surprisingly, improvement in visual function was not correlated with satisfaction in vision. While patient understanding, expectations, and achieved VF-14 score did correlate with satisfaction, when controlling for other factors, only achievement-expectation discrepancy was independently predictive. Conclusions: This study provides support for the expectation-outcome discrepancy model of patient satisfaction. Further, it highlights the highly unrealistic expectations harbored by patients with cataract and emphasizes the importance for physicians to control their patients' expectations. Controlling patient expectations may be more effective than improving patients' postoperative outcome in terms of maximizing patient satisfaction.