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Vision impairment, often caused by age-related and chronic conditions like cataracts, macular degeneration, retinal vein occlusion, and diabetic macular edema, is common among the elderly and significantly reduces their quality of life. Treatments for these conditions, such as medications, injections, or surgeries, can induce anxiety, affecting patient welfare and increasing perceived pain. Common ophthalmic surgeries require patient consciousness and minimal movement, often using local or topical anesthesia, which has a lower risk profile compared to general anesthesia. However, staying conscious during procedures can elevate anxiety, impacting vital signs and potentially worsening conditions like hypertension. Managing perioperative anxiety is crucial for patient comfort and recovery. While anxiolytics are commonly used, there’s growing interest in non-pharmacological interventions like music to enhance the patient experience during ophthalmic procedures. This systematic review and meta-analysis explores the impact of music on patients undergoing these procedures, offering a cost-effective method to improve patient care.
This review followed the PRISMA framework and registered the study protocol on the PROSPERO database (CRD42024502918) to ensure transparency. The selection criteria, based on the PICOS framework, included patients over 18 years old undergoing ophthalmological procedures, excluding those with hearing impairments dependent on hearing aids, mental disorders, or complications during surgery. The intervention focused on music therapy during perioperative procedures, compared to no music intervention. Outcomes measured included physiological anxiety (using STAI and VAS), intraoperative pain (VAS), and vital signs (blood pressure and heart rate). The primary study design was Randomized Controlled Trials (RCTs). Studies on diagnostic procedures, selective outcome reporting, lacking reliable data, or published in non-English languages were excluded.
Interest in using music therapy during ophthalmic surgery has increased recently due to its non-pharmacological nature, offering an alternative to drugs like benzodiazepines and sedative hypnotics. These drugs can lead to complications such as postoperative opioid prescriptions, oversedation, and longer recovery times. Music therapy appears to be a promising strategy for improving patient care and surgical outcomes.
A systematic review and meta-analysis reveal that music therapy significantly reduces anxiety and intraoperative pain, highlighting its therapeutic potential in clinical settings. The reduction in anxiety, measured by the VAS and STAI-S, underscores the psychological benefits of music therapy. Extensive research supports music’s anxiolytic properties, showing effectiveness in reducing procedural anxiety in cancer patients and those with dementia, as well as alleviating pain perception during medical procedures and positively affecting hemodynamics in hemodialysis and hypertensive patients.
However, the impact of music therapy on physiological parameters such as SBP, DBP, and HR showed mixed results. While moderate reductions in SBP and DBP suggest potential cardiovascular stress relief, significant heterogeneity in the data calls for cautious interpretation. This variability could stem from differences in surgical complexity, individual reactions to music, and the types of music used. Notably, music with a binaural beat affected SBP during cataract surgery but did not significantly influence DBP or HR. Personalized music choices in cataract surgery reduced DBP, indicating that the effectiveness of music therapy can be tailored to individual preferences.
The sensitivity analysis confirms the robustness of findings on anxiety and pain outcomes despite considerable heterogeneity. Reanalysis with a fixed-effect model, excluding heterogenous studies, supports the beneficial effects of music therapy. Funnel plots indicate minimal publication bias for anxiety and pain outcomes. The symmetrical distribution and Egger’s test further validate the absence of significant publication bias, enhancing confidence in the results.
This systematic review and meta-analysis highlight the effects of music therapy on patients undergoing ophthalmic surgery but face several limitations. The limited number of studies and small sample sizes reduce the robustness and generalizability of the findings, introducing potential bias. The lack of double-blind methods and heterogeneity in music therapy interventions further complicate the results. Variability in the type of music, timing, and delivery mode affects the outcomes, making it challenging to determine an optimal protocol. Additionally, inconsistencies in physiological parameters like SBP, DBP, and HR underscore the complexity of music therapy’s impact in a surgical setting.
In summary, despite its limitations, this review highlights the value of music therapy as a non-pharmacological intervention in perioperative care for ophthalmic patients. While the impact on physiological parameters is inconclusive, this area offers significant opportunities for future research. Larger sample sizes, robust methodologies, and standardized music therapy approaches are needed to validate these findings. Future studies should also consider patient-specific factors and optimal protocols to maximize therapeutic benefits and understand the underlying mechanisms. Incorporating music therapy in perioperative care is a promising, cost-effective strategy to enhance patient outcomes and satisfaction.
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