Vision-Correction Procedure Linked to Higher Level of Neuroticism Traits

DENVER — Adults opting for small incision lenticule extraction (SMILE) surgery to improve vision exhibited increased levels of neuroticism, which could have implications for counseling and patient satisfaction, investigators in a study from Hong Kong concluded.

A comparison of scores on the Big Five Inventory showed that patients choosing SMILE trended toward personality traits associated with neuroticism as compared with a control group of patients who did not choose SMILE. The 100-patient SMILE cohort and the control group did not differ significantly on traits associated with the other four psychometric domains (extraversion, agreeableness, conscientiousness, and openness).

Additional studies involving larger numbers of patients are needed to gain more insight into the personality traits of patients undergoing refractive surgery, said Tiffany Wu, MBBS, of the University of Hong Kong, at the Association for Research in Vision and Ophthalmology meeting.

“Given the predominance of neuroticism in patients choosing SMILE, it is important to advise clinicians to have an effective doctor-patient communication regarding the expectations, risks, and complications of the procedure, since previous studies have shown that psychological state contributes to patient satisfaction after refractive surgery,” said Wu. “Patients undergoing SMILE may be more difficult to satisfy if postoperative complications arise. It is vital that clinicians provide realistic counseling and avoid over-promising or under-delivering to these patients.”

“Ultimately, integrating an assessment of psychological traits into the consultation process can help manage expectations, optimize counseling, and improve overall clinical outcomes,” she added.

Session co-moderator Yoshinori Oie, MD, PhD, of Osaka University in Japan, asked whether the study included an assessment of the participants’ mental state.

“A study of mental status was not included,” said Wu. “I think you raise a very valid point, given that our study showed that neuroticism tended to occur more in SMILE patients. I think assessing mental status would add value to the study.”

Oie also asked whether patient age might have played a role in the results.

“Age could have played a role, but I think younger patients possibly care more about aesthetics and want to go for SMILE or other types of corrective surgery so that they don’t need prescription glasses,” said Wu. “Whether age is correlated with neuroticism, particularly in the Hong Kong population, there has not been a widespread study specifically targeting whether younger patients are more neurotic than the rest of the population, but I think that is a valid point.”

An unidentified member of the audience suggested that a control population of similar-age patients not seeking corrective surgery might have provided for a better assessment for differences in personality traits, which Wu acknowledged as a valid point for consideration going forward.

By way of background, Wu noted that several studies have examined personality traits of patients undergoing LASIK. For example, a study from China showed that patients seeking LASIK scored higher on dominance and tension and lower on emotional stability as compared with a control group of patients not seeking corrective surgery. The authors interpreted the findings as indicating that patients seeking LASIK are more assertive and suspicious.

A study from Peru showed that patients undergoing LASIK procedures were more likely to be risk takers and to adopt more easily to new situations as compared with patients who decided not to undergo LASIK.

“Both studies suggested that personality profiles of LASIK patients influenced their decision to pursue refractive error correction,” said Wu. “Given similar clinical outcomes between SMILE and laser-treated subjects, we wanted to find out how psychometric properties play a role in the decision-making process regarding choice of SMILE and identify their personality traits.”

The study included 100 patients undergoing SMILE procedures performed by the same surgeon and 75 patients who were not interested in refractive surgery. All participants completed an assessment of psychometric properties, including the Big Five Inventory, a 44-item questionnaire that assesses personality characteristics in five domains.

Subsequently, 78 patients in the SMILE group and 74 in the control group completed the assessment. The SMILE group was older (31.0 vs 26.3, P<0.001) and more likely to be employed in the service/retail sector (25 vs four, P=0.0018). Women accounted for a majority of patients in both groups, which had similar education levels.

Comparison of total scores for the five domains of the Big Five Inventory showed that the SMILE and control groups differed significantly on the neuroticism domain:

• Extraversion: 2.99 vs 2.95, P=0.40
• Agreeableness: 3.11 vs 3.09, P=0.51
• Conscientiousness: 3.20 vs 3.16, P=0.45
• Neuroticism: 3.04 vs 2.94, P=0.04
• Openness: 3.12 vs 3.08, P=0.26

The neuroticism domain comprises personality traits related to levels of anxiety, anger/hostility, depression, self-consciousness, impulsiveness, and vulnerability.

For additional context, Wu and colleagues compared the results with those of an analysis of the geographic distribution of the Big Five Inventory personality traits across 56 countries. That analysis showed that the Hong Kong general population rated highest for neuroticism and lowest for conscientiousness.