Subjective visual experience during phacoemulsification and intraocular lens implantation using retrobulbar anesthesia

J Cataract Refract Surg. 2000 Jun;26(6):842-6. doi: 10.1016/s0886-3350(99)00452-6.


Purpose: To investigate the subjective visual experience of patients during phacoemulsification and intraocular lens (IOL) implantation using retrobulbar anesthesia.

Setting: Department of Ophthalmology, Tan Tock Seng Hospital, Singapore.

Methods: Seventy cataract patients who had routine phacoemulsification and posterior chamber IOL implantation under retrobulbar anesthesia were interviewed on the day of their surgery regarding their visual experience in the operated eye during surgery. Thirty-nine men (55.7%) and 31 women (44.3%) were included in the study. Their mean age was 65.1 years (range 37 to 87 years). Preoperative best corrected visual acuity ranged from 6/12 to counting fingers. Sixty eyes (85.7%) had no ocular pathology other than cataract. Eleven patients (15.7%) reported no light perception during the surgery. The rest reported they could see light (59 patients, 84.3%), 1 or more colors (39 patients, 55.7%), flashes (35 patients, 50.0%), movements (34 patients, 48.6%), instruments (12 patients, 17.1%), and the surgeon's fingers or hands (11 patients, 15.7%). The colors seen included red (23 patients, 32.9%), blue (17 patients, 24.3%), yellow (12 patients, 17.1%), green (7 patients, 10. 0%), and orange (1 patient, 1.4%). Eight patients (11.4%) saw a spectrum of colors similar to a rainbow. Thirty-one patients (44.3%) reported that the brightness of light changed during surgery. Five patients (7.1%) found their visual experience frightening. Patients who reported seeing colors (P =.048, Fisher exact test) and flashes of light (P =.027, Fisher exact test) were more likely to find the experience frightening. There was no statistically significant correlation between those who found the experience frightening and patient sex or age, length of surgery, or history of cataract surgery in the fellow eye.

Conclusions: Many patients having phacoemulsification and IOL implantation under retrobulbar anesthesia experienced a variety of visual sensations that were frightening in a small proportion of cases.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthesia, Local / methods*
  • Anesthetics, Local / administration & dosage*
  • Female
  • Humans
  • Injections
  • Intraoperative Period
  • Lens Implantation, Intraocular*
  • Male
  • Middle Aged
  • Orbit
  • Phacoemulsification*
  • Visual Perception / drug effects
  • Visual Perception / physiology*


  • Anesthetics, Local