Sir,

Ophthalmologists have an ethical and legal obligation to give a fully informed consent so that the patients can make an intelligent decision prior to cataract surgery.1 Serious errors in patient's understanding and recollecting the information given pre-operatively can lead to medical malpractice litigations.2 This prospective study was undertaken to determine the percentage of preoperative information, about cataract and cataract surgery-related complications surgery, retained on the day of surgery.

In all, 82 patients undergoing elective phacoemulsification with intraocular lens implantation were included in this study. At 2 weeks prior to the operation, each patient received a standardised written and verbal explanation about cataract surgery and the possible complications. There were 55 patient's undergoing surgery for the first eye and 27 for the second eye. A study questionnaire was designed to check patient's recall of preoperative information provided on the day of surgery. A trained nurse read out the questionnaire for patient's who had difficulty reading it. Questions, phrasing, and intonation were standardised to avoid any bias. Also, all the questions included a ‘don’t know' option.

In all, 92.3% of patients found the combined information provided by the nurse on pre-operative assessment visit, and through the booklet to be useful. The mean accuracy of correct information recalled was 38.9% in the first eye surgery and even lower in second eye group at 32.9%. This was surprising as the second group of patients not only had heard the consent before but also had undergone both the preoperative process and the postoperative course. Patient's recall of information relating to the complications (including infection, haemorrhage, dropped nucleus, blindness and loss of eye) was poor in both the groups. Patients in our study were questioned on the day of surgery, which is earlier than most of the other studies;3, 4 still the recall of information was poor. It could be argued that the anxiety provoked on the day of surgery might have prompted them to give wrong answers. However, a previously published study5 has shown that the mean anxiety provoked by cataract surgery is more on the day of preassessment than on the day of surgery itself.

Cognition and memory in this elderly group of patients (mean age 76.6±8.2 years) was not measured. Elderly patients and impaired cognition have been associated with poor information recall6 and we believe that these factors played a role in poor information recall. Our study shows that patient's recall minimal of the preoperative discussion. It highlights the importance of ophthalmologists to pursue at exceeding length their patient's education. Verbal and written information supplied to a patient may be understood, but is easily and quickly forgotten.7 To realise the full potential of informed consent, the preoperative discussion must undergo further changes in order to avoid any misunderstanding and potential medico-legal litigations.