Cataract extraction remains one of the most common procedures, yet any type of surgery can be stressful for patients and cause elevated blood pressure, heart rate and IOP. New research published in JAMA Ophthalmology found individuals who listened to music prior to cataract surgery had less anxiety and 39% fewer hypertensive events.

In this randomized clinical trial of 309 adults, its investigators reported the proportion of hypertensive events was 14% in the group who received music intervention vs. 53% in the control arm. A hypertensive event, the study’s primary endpoint, included an incident of systolic BP reaching more than 160mm Hg and/or diastolic BP of more than 100mm Hg combined with a tachycardia level of more than 85bpm.

The investigation, which took place in the Cochin Hospital in Paris, France from 2017 to 2018, enrolled individuals who underwent phacoemulsification for elective cataract surgery in their first eye under local anesthesia. Investigators divided the participants into two groups: 155 were placed in a web app-based music listening intervention delivered via headphones group, and the other participants were given noise-canceling headphones without music. 

Patients in the music arm were shown how to handle the tablet interface (Samsung Galaxy, Samsung) by a nurse or nursing assistant trained in using the Music Care web app with the U sequence technique that is designed to gradually relax the listener. Participants were asked to choose their musical program according to their preferences, set the volume level on the headphones, and start a 20-minute session. In the control arm (155 participants), the same insulating headphones were placed on the participants’ ears but without any music. In both groups, individuals wore their headphones and sleeping mask for 20 minutes.

A total of 310 participants were randomized in the study, but only 309 were analyzed, since one participant in the music arm had already undergone cataract surgery in the other eye. Patients were roughly 69 years old, and females represented 57% of participants.

Considering anxiety levels—the investigation’s secondary endpoint—this metric was lower in the music arm (1.4) compared with the control arm (3.1), or a difference of 1.5. Researchers determined anxiety levels using a visual analog scale rated from zero to 10.

Individuals who listened to music prior to cataract surgery also required fewer midazolam sedative drug injections during the procedure:  0.04 vs. 0.54, or a 0.50 difference.

By reducing hypertension, levels of anxiety and the need for sedative drugs during the procedure, a 20-minute music intervention before cataract surgery based on the U sequence algorithm appears to offer an effective treatment for anxiety, thus highlighting the importance of listening to music in decreasing potential debilitating effects, the authors suggested.

“Furthermore, this treatment is easily accessible and distributable via its computer- and smartphone-based application,” researchers wrote in their paper. “Overall, we would like to stress the positive effects of using a web app-based music intervention as potential large-scale treatment for those who experience anxiety and possibly in the context of other types of surgical procedures.”

Guerrier G, Abdoul H, Jilet L, et al. Efficacy of a web app–based music intervention during cataract surgery: A randomized clinical trial. JAMA Ophthalmol. July 29, 2021. [Epub ahead of print].