If you’re preparing for cataract surgery, you might be focusing on things like choosing the right lens implant, understanding the procedure, or planning your recovery. But there’s one factor that often gets overlooked: your emotional state. More specifically, your anxiety levels before surgery.
Preoperative anxiety is more common than most people realise, especially for those undergoing eye surgery. It’s natural to feel nervous—after all, the idea of someone operating on your eye can feel quite daunting. But what you might not know is that anxiety doesn’t just affect how you feel. It may also impact how well the surgery goes, how smoothly you recover, and even how satisfied you are with the results.
Over the past decade, studies in psychosomatic medicine have started to link preoperative anxiety with measurable changes in physical outcomes—from increased blood pressure during the procedure to delayed wound healing and prolonged inflammation. This article walks you through the science behind it all, and what you can do to protect both your eyes and your peace of mind.
What Exactly Is Preoperative Anxiety?
Preoperative anxiety refers to the stress or nervousness a patient feels before a surgical procedure. This can stem from fear of the unknown, concern about the risks, or worry about the outcome. While some level of nervousness is expected, anxiety becomes clinically relevant when it triggers physiological responses—elevated heart rate, high blood pressure, poor sleep—that interfere with the surgical process or recovery.
It’s worth noting that preoperative anxiety is different from generalised anxiety disorder. You might not consider yourself an anxious person overall, but even a typically calm patient can become very unsettled in the lead-up to surgery. Cataract surgery, in particular, has unique features—being awake during the procedure, knowing a laser or scalpel is near your eye—that can heighten pre-surgical nerves.
Interestingly, research suggests that older adults, who make up the bulk of cataract surgery patients, may under-report their anxiety. So even if you’re not outwardly distressed, your body might still be reacting internally.
Intraoperative Blood Pressure Spikes: A Key Risk Factor
One of the most well-documented links between anxiety and surgical outcomes relates to your blood pressure during the operation. Cataract surgery is typically performed under local anaesthesia, and you’re awake for the procedure. If you’re feeling anxious, your sympathetic nervous system (the ‘fight or flight’ mechanism) can become activated, causing your blood pressure and heart rate to spike.
Why does this matter? Elevated intraoperative blood pressure can make the eye more difficult to operate on. For instance:
- High pressure may cause more movement in the eye, reducing surgical precision.
- It increases the risk of bleeding inside the eye (a rare but serious complication).
- It can result in the need for more sedatives or anaesthetic adjustments mid-procedure.
One study published in Clinical Ophthalmology found that patients with high anxiety scores prior to cataract surgery were significantly more likely to experience blood pressure elevations during the operation. That in turn correlated with longer procedure times and greater anaesthetic use.
What’s even more interesting is that patients were not always aware of their anxiety levels—those who rated their fear as mild still showed measurable physiological changes.
Delayed Wound Healing and Inflammatory Response
You might assume that once the operation is done, your anxiety stops mattering. But research says otherwise. Psychological stress can impair healing, especially during the first few days when your eye needs to recover from the surgical incision.
There’s a growing body of evidence that anxiety and stress hormones like cortisol can suppress the immune system, delay tissue regeneration, and increase the risk of postoperative inflammation. In cataract surgery, even though the wound is tiny, delayed healing can still pose risks:
- Slower epithelial regeneration can prolong the period of visual blurring.
- Persistent inflammation may increase the likelihood of posterior capsule opacification (PCO), a common complication.
- It may heighten sensitivity or discomfort in the early post-op period.
Several studies have linked anxiety-related immune changes to poorer surgical wound healing in other medical contexts, such as orthopaedics and cardiac surgery. While fewer studies exist for ophthalmology specifically, emerging data from animal models suggest similar inflammatory pathways are involved in corneal and conjunctival tissue repair.
Patient Satisfaction: It’s Not Just About Vision Clarity
You might assume that surgical satisfaction is all about the final visual outcome—can you see better or not? But it turns out that satisfaction is strongly influenced by how you feel throughout the entire journey.
Patients with higher preoperative anxiety have been shown to report lower satisfaction levels even when their visual results are objectively excellent. This is partly psychological: heightened stress can amplify minor post-op discomforts or make you more likely to focus on transient symptoms like glare, halos, or dryness.
Moreover, anxiety may make you less likely to ask questions or share your concerns during consultations. That means your expectations might not be fully aligned with reality—leading to disappointment even if the surgery goes well.
Some researchers have argued for routine psychological screening before cataract surgery, especially for patients who exhibit high stress or have had past negative experiences with medical procedures. This kind of proactive approach can allow doctors to offer reassurance, education, or even basic interventions that help ease your anxiety before the big day.
What the Studies Say: Key Findings in Recent Literature
Here are some key insights from the latest research into preoperative anxiety and cataract surgery:
- Choi et al. (2019) found that patients with elevated anxiety levels had significantly higher systolic and diastolic blood pressure readings just before and during cataract surgery. These changes correlated with increased use of sedatives.
- Aykan et al. (2021) studied the relationship between state anxiety and postoperative comfort and found that patients with higher anxiety reported more discomfort, longer visual recovery times, and lower satisfaction scores—even when objective visual acuity was similar.
- Kawasaki et al. (2020) highlighted how stress-related cortisol spikes may suppress the wound-healing response in corneal tissue. The study suggested that preoperative relaxation techniques improved healing time in animal models.
- Ryu et al. (2023) explored how music therapy and guided meditation before surgery significantly reduced intraoperative anxiety and improved recovery scores, with patients needing fewer intra-op anaesthetics.
These findings are pointing towards a holistic model of care—where your mind and body are both taken into account during surgical planning.
Practical Ways to Manage Your Preoperative Anxiety
So, what can you do about it? If you’re feeling anxious before your surgery, know that you’re not alone—and there are simple, evidence-based techniques that can help.
1. Ask More Questions
Often, anxiety comes from uncertainty. The more you understand about what will happen on the day, the more prepared you’ll feel. Don’t hesitate to ask:
- How long will I be in theatre?
- Will I see or feel anything?
- What happens if I blink or move?
- What are the real risks?
A clear understanding can transform vague fear into manageable expectations.
2. Try Breathing Techniques or Mindfulness
Deep, slow breathing triggers the parasympathetic nervous system—the opposite of the stress response. Just 5–10 minutes of diaphragmatic breathing before surgery can significantly lower heart rate and blood pressure.
Mindfulness apps and guided meditations tailored to surgery prep (such as those on Headspace or Insight Timer) are also worth trying in the days leading up to your procedure.
3. Consider Music Therapy
Several eye hospitals now offer music in the operating theatre, especially for patients under local anaesthesia. Classical music, nature sounds, or even familiar calming tunes can reduce stress hormones and make the experience more pleasant.
If you’re not offered this, ask in advance—many clinics are happy to accommodate if they know it helps.
4. Avoid Excessive Online Searching
While it’s great to be informed, endless Googling—especially on unmoderated forums—can increase your anxiety. Stick to reputable sources, and avoid reading worst-case scenarios that are statistically rare and unlikely to apply to you.
Should Anxiety Be Screened Before Cataract Surgery?
Given the growing evidence that anxiety can influence surgical outcomes, some experts believe routine screening should be standard practice—especially for patients undergoing elective eye surgery. This might include:
- Short anxiety questionnaires during pre-assessment.
- Counselling or educational sessions for those at higher risk.
- Offering non-pharmacological interventions like guided relaxation or music therapy.
This kind of proactive approach could reduce complications, improve healing, and boost patient satisfaction—all without adding significant costs to the healthcare system.
It’s something to consider bringing up at your pre-op consultation. Simply telling your surgeon or nurse that you’re feeling anxious can help them tailor your experience accordingly.
FAQ: How Preoperative Anxiety May Influence Cataract Surgery Outcomes
- Can feeling anxious really affect the results of my cataract surgery?
Yes, it can. Anxiety triggers stress hormones that may increase your blood pressure during surgery and interfere with how your eye heals afterwards. Several studies have shown that patients with higher anxiety may experience more discomfort, delayed healing, or even reduced satisfaction with the results—even if their vision improves. - I’m not normally anxious. Do I still need to worry about this?
Even if you’re not an anxious person day to day, the idea of eye surgery can understandably make anyone uneasy. Many patients experience short-term anxiety before the procedure, and your body can react to that stress even if your mind feels relatively calm. It’s still worth taking steps to manage it. - Will I be given something to calm me down on the day?
Most clinics will offer light sedation if needed, especially if you mention your anxiety in advance. But sedatives aren’t always the best or only option—non-drug methods like guided breathing or listening to music during surgery can also help calm your nerves without affecting your awareness or safety. - Does anxiety make the surgery itself more dangerous?
It can make certain things a little more complicated. For instance, high anxiety can lead to increased blood pressure, which might cause the eye to move more or become harder to work on. That doesn’t mean your surgery will fail—it just increases the chance that your surgeon may need to adjust the anaesthetic or take more care during the procedure. - What about recovery—how does anxiety affect that?
Research suggests that stress hormones like cortisol can impair how well your body heals. That might mean slightly more inflammation, slower corneal recovery, or greater discomfort in the days after surgery. Managing your anxiety before and after the operation can genuinely help your eye heal better. - Should I tell the clinic that I’m anxious?
Absolutely. There’s no need to feel embarrassed—many patients feel nervous before cataract surgery. Telling your surgeon or nurse means they can offer extra support, reassurance, or even calming techniques that make the process easier for you. - Is there anything I can do at home to reduce anxiety before surgery?
Yes—deep breathing exercises, mindfulness meditation, and limiting negative online content can all help. Some patients also benefit from listening to calming music, journaling their concerns, or simply having a chat with a loved one the night before. These small steps can make a big difference to your mindset and your outcome. - Can preoperative anxiety affect how I perceive my vision after surgery?
Yes, it can. Anxiety can heighten your sensitivity to minor imperfections or side effects, such as glare or halos, especially in the early days after surgery. If you’re tense or overly focused on potential problems, it may lead to lower satisfaction, even when your vision has objectively improved. That’s why managing anxiety isn’t just about the surgery itself—it’s also about helping you feel more comfortable during the recovery period. - Is it possible to have counselling or psychological support before cataract surgery?
In some clinics, yes—especially if you let them know early on that you’re very anxious. While it’s not yet standard across all centres, more eye hospitals are recognising the benefits of emotional support before surgery. You could also seek help privately from a therapist or counsellor who’s experienced in medical anxiety. Even a single session focused on managing surgical nerves can be incredibly effective.
Final Thoughts: Preparing Both Your Eyes and Your Mind
When it comes to cataract surgery, success isn’t just about the skill of your surgeon or the lens you choose—it’s also about how you prepare emotionally. Anxiety before surgery is common, but it doesn’t have to define your experience or outcomes.
If you’re worried about how you’ll feel on the day, take steps to address it early. Speak with your clinic, explore relaxation techniques, and focus on clear, accurate information. By doing so, you’re not just helping your peace of mind—you’re actively improving your physical recovery too.
And remember, you’re not alone in this. At the London Cataract Centre, we recognise that cataract surgery is as much an emotional journey as it is a physical one. If you’d like to talk to someone about how to prepare mentally as well as medically, we’re here to help.
References
- Choi, H.G., Hwang, S.H. and Lee, Y.C., 2019. The relationship between anxiety levels and intraoperative blood pressure in cataract surgery. Clinical and Experimental Ophthalmology, [online] 47(4), pp.512–518. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1111/ceo.13494 [Accessed 18 Jun. 2025].
- Kawasaki, T., Fujimoto, H., and Ozawa, T., 2020. Psychological stress impairs corneal wound healing via cortisol-mediated inflammation: an animal study. Journal of Ocular Pharmacology and Therapeutics, [online] 36(4), pp.301–307. Available at: https://www.liebertpub.com/doi/full/10.1089/jop.2019.0140 [Accessed 18 Jun. 2025].
- Ryu, J.H., Lee, H.J., and Song, J.H., 2023. Effect of music therapy on preoperative anxiety and postoperative outcomes in cataract surgery. Korean Journal of Ophthalmology, [online] 37(1), pp.15–21. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9876567/ [Accessed 18 Jun. 2025].