Anxiety is a common issue among patients undergoing laser in situ keratomileusis (LASIK), a widely used procedure to correct refractive vision problems such as myopia and hyperopia. A recent study conducted at two eye-specialty centers demonstrated a significant correlation between the severity of patient anxiety and fixation instability during this eye surgery. This innovative research, published on March 18, 2025, aims to develop a novel quantitative scale for measuring anxiety-related fixation instability, providing an important tool to enhance patient care and surgical outcomes.
The study assessed 2,435 eyes from 2,435 patients who underwent LASIK procedures, including both microkeratome-assisted and femtosecond laser-assisted techniques. Participants were evaluated for anxiety levels using the seven-item anxiety sub-score of the Hospital Anxiety and Depression scale (HADS) prior to surgery. Fixation instability is a critical concern during LASIK, as high levels of eye movement can lead to poor surgical outcomes.
The researchers collected eye-tracking data on the positions of the pupil center during surgery, alongside objective measures such as heart rate and surgeon reports on patient cooperation. These parameters were analyzed to compute an anxiety-related fixation instability score (FIS), which ranges from 0 to 90. According to the study’s findings, scores of 0-12 indicate normal anxiety, 13-36 suggests borderline anxiety, and scores from 37-90 signify anxiety cases.
Dr. H. Abdelmotaal, who led the research, stated, "This novel scale allows us to quantify anxiety-related fixation instability during LASIK, ultimately leading to better surgical outcomes. Anxiety can influence patient cooperation and hence the procedure's success. By assessing anxiety scores, we aim to mitigate the potential risks that come with high anxiety levels during eye surgeries."
The study, conducted from August 2018 to July 2023, sheds light on the relationship between psychological factors and surgical effectiveness in the LASIK patient population. By specifically measuring fixation instability through eye-tracking technology, the research reveals how anxiety manifests during the surgery.
During the research, heart rate was chosen as an objective measure of anxiety, and significant increases were recorded across all anxiety subscale groups during different phases of the procedure. Interestingly, the mean HADS-anxiety sub-score across participants was 5.5, with 35.5% identified as experiencing anxiety symptoms. Furthermore, stratification of data revealed notable differences in the number of males and females categorized within the anxiety case group.
The fixation instability score (FIS) was particularly effective as a classifier; its performance yielded an impressive accuracy of 92% in distinguishing between normal, borderline, and anxiety classifications. This advancement in assessment techniques empowers surgeons with a numerical tool to tailor preoperative patient education and intervention strategies.
"Understanding how anxiety correlates with fixation stability is crucial, as it helps us create better environments for our patients during surgery. We believe that implementing anxiety reduction strategies can lead to improved cooperation and enhanced outcomes," Dr. Abdelmotaal remarked.
Surgery participants were provided with extensive preoperative education regarding what to expect, aiming to alleviate anxiety related to the surgery experience. The researchers also correlated the findings with demographic data, which illuminated trends affecting anxiety levels, such as gender and age.
LASIK remains a popular surgical option given its quick recovery times and effective results. However, as surgeries can be anxiety-inducing, the correlation of anxiety levels with fixation instability suggests the need for improved psychological support mechanisms pre- and post-operation. The team encourages further research to explore how these findings can inform protocols to reduce patient anxiety prior to surgical interventions.
As a practical application of this research, the FIS could be utilized to stratify patients based on anxiety levels, allowing for personalized preoperative approaches that account for psychological factors, ultimately enhancing patient cooperation and procedural success.
The findings of this study raise critical questions about how the surgical experience can be engineered to lower anxiety and improve focus. As the medical community continues to navigate the psychological barriers in surgical processes, this research stands as a cornerstone for future studies addressing anxiety-related challenges in LASIK and possibly other surgical fields.
