 Well, good morning everyone. My name is Brian Kirk. I'm a fourth-year medical student here at the University of Utah And I'm here to talk about a study that I've been helping with recently here at the Moran With the Dr. Craig Chia Derek Zikata Bob Langston many others and several of whom are in this room were Participated in this study so There's a question as to the patient experience with sequential cataract surgery and specifically the question we looked at is the Pain comparison between the first eye and the second eye and there's a lot of anecdotal stories and several studies Which I kind of selected a few to put up here that suggests that patient actually experiences more pain with the second eye Surgery is compared to the first eye surgery And as you can see this they the percentage ranges that were from 40 to almost 50 percent Although not all studies agree with that as some studies have found no difference in the pain score And if you think about it Why is this important beyond just wanting to do the best for our patient and decrease their pain during cataract surgery and one of the Important things especially for topical or cataract surgery done purely under topical anesthetic is patient cooperation during the surgery As you can see by this study and it's intuitive that patient has more pain during the surgery They're going to be less cooperative with the surgery which is important for Surgery surgical outcomes as well as pain and anxiety are important determinants for patient satisfaction scores Which have been more important in medicine recently? As to the theories of why someone may feel more pain or discomfort during their second surgery There's several of them out there some of them are listed here One of the leading ones is that someone just has more has more awareness increased awareness They've already been through the process once they're able to notice different things They didn't notice the first time and that makes them remember the experience more and therefore Remember more pain another reason could be That just memory distortion as time passes we kind of forget the bad experiences We might have had a little bit further in the past and the second surgery being the most recent Maybe easier for them to remember the pain There's also theories in terms of increased tolerances to the anesthetic that they're given as well as others But those are some of the main ones So the study design that we for a study here was a prospective observational study and the unique aspect of our study was trying to combine the subjective questionnaire information and patient feedback data with an objective interoperative data and So the objective interoperative data Which was I mentioned the unique part of the study was gathered using this device here a picture of a handheld device This was designed by dr. Derek Zikata and shad roundy from the mechanical engineering department on lower campus As you can see this is a device designed to be held in the patient's hand And it records several parameters So you can see there's a button on top and this is for patients to press if they have any discomfort as the procedure is ongoing It also records squeezing like a grip force Many has acceleration sensors to detect any movement. There's also sensors that can take can that can detect skin conductance Which can detect sweating which is a physiological response to stress This device is paired wirelessly through Bluetooth to a tablet that can record and store the information and Okay, so that's about the device so back to the study the study subject are recruited from the patients of these Cataract surgeons here at the Moran ice center These people were identified as being scheduled for bilateral Sequential cataract Extraction they were contacted with the letter and then pre-consented prior to surgery Via phone call met on the day of surgery and consented prior to their operation It's to be included in the studies the patient need to be more than 18 years old be scheduled for sequential cataract surgery And be receiving only topical anesthesia Some of the exclusion criteria was a resident surgery for either the first or the second eye And this was done mainly to decrease the variation in surgeon experience For the patient There's any complications or also as we define surgery lasting greater than 30 minutes for either the first or second eye that would they're also Excluded surgery happy more than six months after their second eye surgery happy more than six months after their first eye surgery Or any pre-existing conditions that could confound the analysis of pain like any inflammatory conditions uncontrolled glaucoma, etc All right, so The study is set up to examine the patient experience in three stages The pre-operative interoperative and post-operative stage so in the pre-operative stage once a patient was on their day of surgery, but prior to Being operated on we assess both their anxiety and pain anticipation for the surgery This was done using a questionnaire the anxiety was assessed using a simplified six-question state trait anxiety index and the pain anticipation was done using a visual analog scale So basically a 10 centimeter line Asking patients how much pain they expected to experience during their surgery They'd make a mark somewhere along that line with the left side being no pain and the right side being extreme pain Right. This is prior to surgery So interoperatively the data was gathered by the handheld device that we discussed earlier as well as a research Assistant would go back with the patient to the operating room to record that device data and also make time notes on the time During the different steps of the cataract surgeries Hopefully in the end correlate maybe increase button clicking or pain or movement with specific steps during cataract surgery Post-operatively a very similar survey to the pre-operative survey was given again to assess the anxiety and pain recall Through the same tools and this was done for both the first eye and the second eye surgery With them only real difference with the second eye surgery immediately after their Surgery was done. They were asked to think back to their first surgery and compared the pain They had just recently experienced with the pain the experience or they remembered experiencing with their first surgery and the final step of the study is a one-month post-operative follow-up questionnaire and this Questionary kind of assessed a broad experience perception of their surgery, you know experience with cataract surgery as well as Had a similar question as that they were asked Immediately post-operatively after their second surgery asking them to think back and compare their pain from the first surgery and the second surgery And this was done to kind of maybe eliminate that recency bias with the second surgery and the question being asked right afterwards So as far as results today, we're actually still in the process of gathering some data there's several patients roughly 10 patients who will soon get their follow-up questionnaire and The device data we have a wonderful statistician Molly McFadden who's still kind of crunching the data on that it generates an enormous amount of data Hundreds of data points every second for all the surgery. So she's trying to be able to present that in a meaningful and useful way But we do have a most of the survey results today so kind of a broad perspective we enrolled 101 patients and Unfortunately, 23 patients were excluded with the most common reason being resident Surgery other reasons would be surgical complications Surgery as was mentioned before surgery going or occurring more than six months after their first die Etc. But 78 patients were included in this analysis So here are the results or the averages of patients anxiety scores for their first surgery and This was done as I mentioned with that anxiety index and the max score is 24 So the higher the score the more anxiety someone feels so as would be expected someone people going through their first surgery They have a decrease in anxiety After their surgery when compared to the beginning So looking at the anxiety scores from the second surgery again You see the same thing where they start off a little more anxious than they end up after the surgery and An interesting thing to note here is that both the post surgery pre-surgery and post-surgery Anxiety scores were decreased for them were significantly decreased for the second surgery Which lends credence to the theory that people are maybe a little less anxious for their second surgery and therefore more aware of what's going on And able to better remember their experience Now looking at the pain assessment scores for the first surgery we can see again There's a decrease Well, they seem to overestimate their pain that that top number the pre-surgery is what they anticipated feeling on a scale of 1 to 10 and that post-surgery is what they reported Experiencing the average difference going down about 1.3 on that scale Now looking at the second surgery pain scales So pre-surgery it appears they slightly underestimated their pain But unfortunately that difference between the pre-surgery and post-surgery is not statistically significant But there you do see that they're When comparing the first side with the second eye patients pre-surgery Have a statistically significant lower anticipated pain prior to their second surgery And post-surgical evaluation of pain again is slightly higher for the second eye surgery But again that was not shown to be significant So as was mentioned immediately after their second eye surgery They were asked to think back and compare their pain with the first surgery versus the second surgery And you can see that the majority of people reported feeling the exact same or roughly the same amount of pain for both surgeries But among the people that reported a difference in pain the majority of them reported that more pain occurring in the second eye And this trend held true for the one month follow-up survey again. We're still collecting this data but Again, the majority of people reported the same pain among those reported different pains. The second eye was more painful So just in conclusion For what we've learned so far is that anxiety has decreased Overall both pre and post-surgery from the first surgery to the second surgery And the also the anticipated pain prior to you the first surgery compared to the second surgery was also decreased There was no difference in immediate post-operative post-op scoring for the two surgeries And the subjective comparison of pain In the follow-up and immediately post-operatively among those who thought the pain was different the second eye seemed to be more painful So there's still quite a bit more to do. Of course, we have all the device data Which is probably the most interesting aspect of this study Which we hope to be able to share soon And we have the follow-up surveys that we're still collecting and we're also hoping to include Some measure of the anesthetic that the patients received and Correlating that to their pain and anxiety scores as well All right, I just want to thank dr. Chai dr. Sikata bob all the surgeons and OR staff to Let us do this study and thank you if there's any questions. I'll take them