Sir,

I am indebted to Mr Au Eong for pointing out some inaccuracies in the Information for Patients (Appendix 1) section of the Royal College of Ophthalmologists Cataract Surgery Guidelines and for documenting the clinical studies on the subject.1 It is of course correct to say that patients may lose some or all of their vision after receiving local anaesthetic, particularly if given by the retrobulbar or peribulbar route, and during surgery they may experience a number of visual sensations, most usually a variety of colours.

The challenge however when writing patient information is to keep the advice clear and succinct for the majority, and yet not misleading.

Patients do need to be reassured that they are not going to ‘see the operation’ in detail, and warned that they will be dazzled (in the majority of cases, 100% with topical anaesthesia) by an extremely unpleasant bright light at the beginning of the operation. It is these aspects that are most likely to cause concern without prior warning.

Happily nowadays the more invasive forms of local anaesthesia are becoming increasingly rare in the UK, and hence the advice is most relevant for patients undergoing sub-Tenon's or topical anaesthesia.

I agree that there is a place for additional preoperative counselling in order to cover more completely the variety of sensations that the patient may experience so as to allay potential fears. Once suitably reassured, however, the vast majority of patients undergoing cataract surgery under topical anaesthesia (without sedation) who are able to hold a hand and listen to music are remarkably positive about their experience.

It is equally important to warn patients that they may not be able to see immediately afterwards until the dazzle from the operating light has worn off.