LASIK's Link to Cognitive
BY ANTHONY J. PHILLIPS, OD, AND KRISTYN KEMP, PHD
Surgical groups carrying out refractive surgery have made many claims for high levels of "patient satisfaction," often quoting figures of over 95 percent. This contrasts with results often found by
practitioners at subsequent routine eye examinations and other studies showing, for example, significantly reduced post-operative low contrast sensitivity. Are patients really totally happy in nearly every single case?
Cognitive Dissonance Theory
In some situations, what an individual does can change his attitude. According to social psychologists, this is an attempt to reduce cognitive dissonance (discord) by a change in personal belief.
Suppose that there is some inconsistency between a person's attitudes and his behavior. How can the person now reconcile the inconsistency? He cannot change his behavior because that is past and gone. All he can do is change his present attitude.
Consider the justification of effort. An individual who goes through a difficult initiation rite to join a club, then later finds that the club is really rather dull, might feel like a fool. To avoid this and maintain a favorable self-image, he will either leave the club or over-value the group membership. This will reduce his cognitive dissonance.
Next, suppose an individual has purchased something that he cannot easily afford, like a luxury car. To avoid cognitive dissonance, the person will justify his reasons for purchasing the car. For example, it has seven air bags and is therefore safer. This person has paid out a considerable sum of money which he now must justify to himself and others.
The Connection with LASIK
LASIK surgery is a classic scenario such as the one given above. A recent interview by one of the authors (AJP) with a former 6.00D dentist went along the following lines:
AJP: "So how did your LASIK surgery go?"
Patient: "Extremely well."
AJP: "So you are very happy with the result?"
Patient: : "Absolutely!"
AJP: "And would you recommend it to others?"
Patient: "Most definitely!"
AJP: "So you would classify it as 100 percent successful?"
Patient: "Oh, no."
AJP (surprised): "Why not?"
Patient: "I estimate that I am still around 1.00D short-sighted."
AJP: "So why don't you go back to the surgeon?"
Patient: "I have already had three enhancement procedures."
AJP: "If I had left you with a 1.00D residual error in your contact lenses or spectacles you would be moaning like fury. Why are you telling me that it was so successful and you are so happy?"
Patient: "Well, it's just the freedom of not having to rely on my contact lenses. And I always used to worry that if I was
involved in an accident, and lost my contact lenses or glasses, I would not be able to find my way out."
Now it may well be that the freedom of being without contact lenses is worth the corneal thinning and the blur the patient now experiences. However, the second justification (the accident) almost certainly represents cognitive dissonance avoidance, a change in attitude to justify to herself and to others the considerable expense, the risks involved and yet with an imperfect result.
Simple surveys by some surgical groups quoting patient satisfaction levels are likely to give erroneously high results. More
accurate figures must come as a result of both carefully controlled psychological subjective testing and objective clinical testing by independent practitioners.
Dr. Phillips practices in a specialized contact lens practice in south Australia and is head of the contact lens units at the Flinders Medical Centre, Flinders University and the Adelaide Women's & Children's Hospital.
Dr. Kemp is a clinical psychologist, currently at the Family Court of Australia, Adelaide
Contact Lens Spectrum, Issue: February 2001