Impacts of Anxiety Levels and Personality Traits on Patient Cooperation during Small Incision Lenticule Extraction (SMILE): A Nested Case-Control Study

Abstract

Background Small incision lenticule extraction (SMILE) surgery conducted for the correction of myopia and astigmatism exhibits excellent safety, efficacy, and predictability. However, poor intraoperative cooperation may lead to various adverse outcomes, including ablation decentration, suction loss, and incision tear. Moreover, it is difficult for surgeons to predict the occurrence of poor cooperation prior to the surgery. In this context, the present study aimed to analyze the impact of anxiety and personality traits on cooperation during SMILE surgery to assist surgeons in identifying patients at high risk for poor cooperation. Methods A nested case-control study was conducted at Tongji Hospital, Huazhong University of Science and Technology, between June 2022 and August 2022. Participants were categorized as those exhibiting excellent or poor cooperation based on their performance during surgery. Anxiety levels were quantified using the State Anxiety Inventory (STAI-S) and Trait Anxiety Inventory (STAI-T). Personality traits were evaluated using the four subscales of the Eysenck Personality Questionnaire (EPQ-RSC), namely, psychoticism (P-scale), extraversion (E-scale), neuroticism (N-scale), and lie scale (L-scale). Results The incidence rates were higher for the first-eye procedure compared to the second-eye procedure. The anxiety levels demonstrated an initial trend of increase followed by a decrease, both prior to and after the surgery (P < 0.05). The poor cooperation group presented higher STAI-S scores (P < 0.05) 30 min prior to surgery compared to the excellent cooperation group. Patients with poor cooperation during the procedures for both eyes exhibited higher anxiety levels compared to those with poor cooperation during just the first eye (STAI-S: 11.02 ± 3.05 vs 12.32 ± 3.0, P = 0.016; STAI-T: 10.30 ± 2.87 vs 11.89 ± 2.91, P = 0.002). The binary logistic regression analysis revealed that higher STAI-S and STAI-T scores were associated with a higher risk of poor cooperation (P < 0.05). In the neuroticism scale, scores above 61.5 were associated with a higher risk of poor cooperation (first-eye OR = 1.9; P < 0.05, second-eye OR = 2.395, P < 0.05) compared to scores below 38.5. Conclusion Patients with elevated anxiety levels and typical neurotic personality traits are more likely to exhibit poor cooperation during SMILE surgery.