Vision Impairment by Choice: Why Do Patients Decline Macular Hole Surgery?

Abstract

Introduction: Vision care providers generally assume that patients who are affected with treatable vision impairment are interested in appropriate medical options. It has been our clinical experience, however, that approximately 10% of macular hole (MH) patients opt to decline surgery, even though its beneficial effects have been well established. They, thereby, choose to remain visually impaired in the affected eye. The present study investigated visual acuity in the unaffected eye, living distance from the hospital, and the presence of other age-related medical conditions as possible factors in the decision-making process of seniors affected with MH. Method: Thirty patients (aged 59-81 years) who declined treatment between 1998 and 2003 were matched on age and gender with a group of patients who chose the surgical intervention during the same time period. Information from their medical files was used for statistical comparison. Results: The groups did not differ statistically with regard to acuity in the other eye, living distance from the clinic, or the number of other medical conditions. Conclusion: The results indicate that these three variables do not seem to play an important role in the patients' decision-making process. The required 24-hour face-down positioning for approximately three weeks after surgery, as well as possible aspects of each patient's personality and social environment, may carry heavier weight. In addition, patient education and patient-vision care provider interaction are discussed. No patient has declined surgery since a research psychologist in the clinic started supplying potential surgical candidates with additional information and an opportunity to ask individual questions.