Exploring multifocal IOL experiences: A qualitative study of patient and physician narratives on YouTube

Abstract

This study aims to compare patient- and physician-generated YouTube videos on multifocal lens surgery experiences, examining how online narratives align with or diverge from professional medical perspectives. A cross-sectional qualitative analysis of 48 Turkish-language YouTube videos related to multifocal lens surgeries was conducted. Inclusion criteria required videos to be longer than 1 minute, have at least 1000 views, maintain suitable visual quality, and exclude direct advertising. The final sample included 38 doctor-produced and 10 patient-produced videos. Transcripts totaling 62,707 words underwent thematic analysis, with 2 researchers independently coding the data. Seven themes emerged: patient satisfaction and managing expectations, night vision problems and dysphotopsia, importance of individualized lens selection, technological advances in lenses, postoperative adaptation and management, ethical issues and patient information, and surgical procedure’s practical aspects. Both doctors and patients largely agree that proper preoperative counseling and realistic expectations are key to favorable outcomes. Patients generally confirm good vision and comfort but may experience dissatisfaction when initial hopes are unmet or communication is insufficient. Dysphotopsias and adaptation periods are recognized by both groups as common, albeit temporary. Notably, patient videos attracted higher viewer engagement, suggesting that personal narratives resonate strongly with the audience. Online patient narratives both reinforce and, at times, question the information provided by physicians, highlighting the importance of clear communication, personalized intraocular lens choices, and active expectation management throughout the treatment process. management. For primary care physicians and ophthalmologists, integrating these insights can enhance patient education, improve the referral process, and ensure that evolving IOL technologies better meet patient needs and experiences.

1. Introduction

The advent of advanced intraocular lens (IOL) technologies, including multifocal lenses, has significantly enhanced the management of cataract and presbyopia, often reducing the need for spectacles and improving overall visual acuity.^[1–3] While these lenses generally yield high satisfaction rates and better intermediate visual quality, patients’ individual experiences remain heterogeneous.^[4,5] Factors such as dysphotopsia (e.g., halos and glare), the duration of postoperative adaptation, and the quality of preoperative counseling can all influence patient-reported outcomes.^[6,7]

From advanced artificial intelligence systems to computer-aided diagnostic methods, healthcare systems continue to become digital.^[8,9] The first step of this digitalization is perhaps social media platforms. Social media platforms, particularly YouTube, have emerged as accessible sources of both professional guidance and patient narratives.^[10,11] Ophthalmologists and other healthcare professionals, including primary care physicians, can use these channels to share educational content, while patients discuss their surgical experiences, recovery processes, and satisfaction or dissatisfaction with lens performance. Understanding where these perspectives align or diverge is crucial for refining preoperative communication, managing expectations, and ultimately improving patient-centered care.

While prior studies have explored the educational potential of YouTube and the general quality of health information available online, comparative qualitative analyses between patient-generated and physician-generated narratives regarding multifocal IOL surgeries remain scarce.^[12] This lack of research limits our understanding of how digital discourse aligns or diverges across professional and experiential domains, potentially affecting clinical communication and patient decision-making.

This study aims to address this gap by thematically analyzing Turkish-language YouTube videos from both patients and physicians to compare their perspectives on multifocal IOL experiences. The insights gained may inform better patient education and expectation management during clinical consultations.

2. Materials and methods

2.1. Study design

This cross-sectional qualitative study employed a thematic content analysis of 48 publicly available YouTube videos focusing on “multifocal lens” topics. All videos had been uploaded within the last 10 years. Inclusion criteria required videos to be longer than 1 minute in duration, to have accumulated at least 1000 views, to exhibit suitable visual quality (above 240 pixels resolution), and to be devoid of direct advertising content or copyright violations. The videos, presented in Turkish, encompassed both doctor-produced and patient-produced content, enabling comparative analysis of perspectives on multifocal lens surgeries. The study aimed to understand differences in perceptions, expectations, and experiences related to multifocal lens interventions.

2.2. Data collection and analysis

An extensive set of language-specific keywords was used to locate relevant videos (e.g., “smart lens,” “multifocal lens,” “smart lens usage,” “smart lens benefits,” “smart lens surgery,” “I had smart lens surgery,” “trifocal lens,” “my experience with smart lens,” “life after smart lens”). For each keyword, the first 100 search results on YouTube were manually screened. No geographic or upload date filters were applied. Videos were excluded if they were duplicates, advertisements, irrelevant in content, or lacked audio/visual clarity. Relevance was judged based on video title, description, and preview. All inclusion and exclusion decisions were made jointly by 2 researchers. Search and review continued until data saturation was reached, resulting in the selection of 48 videos. Audio recordings were transcribed verbatim using dictation software, and transcripts were verified by the researcher for accuracy. In total, the 48 transcripts encompassed 62,707 words. Videos were coded into 2 primary categories: doctor-produced videos (n = 38) and patient-produced videos (n = 10), based on the identity of the presenter and the content focus. Notably, videos originating from non-health-focused channels, such as excerpts from television talk shows or variety programs, were also classified as doctor-produced videos if the primary content featured a physician explaining the topic. Each video was assigned a unique identifier to facilitate systematic analysis and comparison. Videos produced by doctors were labeled with a “D” followed by a number (e.g., D1 to D38), while videos produced by patients were labeled with a “P” followed by a number (e.g., P1 to P10). A complete list of the included videos, along with their titles, channels, view counts, and URLs, is provided in Supplementary File 1, Supplemental Digital Content, https://links.lww.com/MD/P677.

Data were analyzed using thematic analysis, following Braun and Clarke 6-phase approach.^[13] Initially, 2 researchers independently reviewed a subset of the transcripts to identify potential themes through open coding. These codes were then compared and refined in a consensus meeting, during which a structured codebook was developed to ensure consistency across the full dataset.

Both researchers proceeded to code all 48 transcripts independently using NVivo software. Any discrepancies were discussed and resolved through consensus, ensuring inter-coder agreement. Although no formal statistical measures were applied, the iterative process of discussion and refinement served as a robust means to maintain consistency.

Once no new information emerged from additional data, the coding process ceased. Seven final themes were identified: patient satisfaction and managing expectations, night vision problems and dysphotopsia, the importance of individualized lens selection, technological advances in lenses, postoperative adaptation and management, ethical issues and patient information, and surgical procedure’s practical aspects. NVivo software facilitated the content analysis, and including illustrative quotes enhanced the trustworthiness and clarity of the findings.

2.3. Use of AI tools

In this study, QuillBot and DeepL, 2 artificial intelligence-based tools, were utilized as supplementary aids during specific stages of the research process. QuillBot was employed to refine and clarify lengthy and complex transcripts, improving their readability prior to thematic coding. DeepL was utilized for accurate translation of Turkish-language transcripts into English to ensure consistency and reliability in the subsequent analysis. The researchers maintained full responsibility for reviewing, validating, and interpreting all data, ensuring that the outputs of these tools adhered to the study’s academic and methodological standards.

2.4. Ethical approval

Because the study involved analyzing publicly accessible videos without direct involvement of individuals as research subjects, no individual informed consent was required. Ethical approval for this study was obtained from the Non-Interventional Clinical Research Ethics Committee of Erzincan Binali Yildirim University (date: November 7, 2024, no: 15/07). The study adhered to recognized qualitative research standards and reflective practices to ensure rigor, credibility, and methodological transparency. We adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines throughout the research process to ensure methodological rigor and transparency.

3. Results

A total of 48 videos were analyzed, including 38 videos from doctors and 10 videos from patients. The average view count and like count for videos created by doctors were 24,584.2 and 215.4, respectively, whereas these figures were higher for patient videos, with averages of 26,536.3 views and 433.8 likes.

The view-to-subscriber ratio for doctor videos was 11.14, while the like-to-subscriber ratio was 0.011. In comparison, patient videos exhibited higher ratios, with a view-to-subscriber ratio of 25.87 and a like-to-subscriber ratio of 0.023 (Fig. 1).

Figure 1.

Comparison of viewer engagement metrics between doctor-generated and patient-generated videos on multifocal IOLs. IOLs = intraocular lenses.

Table 1 summarizes the key findings, highlighting areas of agreement and divergence between doctor- and patient-produced content on advanced intraocular lens experiences.

Table 1.

Key findings by thematic category.

Thematic category	Key findings
Patient satisfaction and managing expectations	Both doctors and patients report generally high satisfaction with improved vision post-surgery. Physicians emphasize proper preoperative counseling and realistic goal-setting. Most patients confirm positive outcomes, though a minority express dissatisfaction when initial expectations are not adequately managed.
Night vision problems and dysphotopsia	Halos, glare, and related night vision issues are widely acknowledged as common but typically transient. Doctors emphasize that these phenomena diminish over several months, while patients report initial discomfort followed by gradual adaptation. Differences in lens type (e.g., ringed vs flat) may influence symptom severity.
Importance of individualized lens selection	Successful outcomes hinge on personalizing lens choices. Both clinicians and patients stress that factors like eye health, occupation, and lifestyle should guide lens selection. No single lens universally fits all patients, aligning with calls for personalized surgical planning.
Technological advances in lenses	Physicians highlight ongoing innovations (e.g., trifocal, EDOF, and ringless “edflex” lenses), and even AI-assisted adjustments. Patients, in turn, focus on brand quality and lens configuration. Both sides indicate cutting-edge technology plus tailored selection yields improved outcomes.
Postoperative adaptation and management	Both perspectives acknowledge that achieving full comfort and stable vision can take months. Patients describe diverse recovery trajectories – some rapid, others protracted – but adherence to medication protocols, patience, and self-care foster smoother adaptation.
Ethical issues and patient information	Physicians stress transparent communication of risks, benefits, and potential side effects as an ethical responsibility. Some patients feel insufficiently informed or believe their concerns were dismissed, indicating that honest, empathetic communication enhances trust and patient satisfaction.
Surgical procedure’s practical aspects	Despite the surgery’s complexity and skill requirement, it is reported as quick, relatively painless, and comfortable by both doctors and patients. Minimal discomfort, short procedure duration, and swift partial recovery reflect refined techniques and advanced lens technologies.

3.1. Patient satisfaction and managing expectations

Across both physician- and patient-generated content, there is general agreement that multifocal lens surgeries often yield high satisfaction and substantially improved visual acuity. Physicians stress thorough preoperative counseling and realistic goal-setting as keys to success. Patients largely confirm these positive outcomes, but rare instances of dissatisfaction arise when medical professionals fail to adequately address or guide initial expectations.

3.1.1. Doctor perspectives

• “Lens technology has advanced significantly, and patient satisfaction has greatly increased.” (D9)

• “Patients who are properly informed from the beginning are very happy when they wear smart lenses.” (D37)

• “If the right lens is used in the surgery and calculations are made correctly, patients are very satisfied.” (D18)

• “Even though the surgery went very well, the patients can say they are not happy enough.” (D1)

3.1.2. Patient perspectives

• “I am very happy because I can see it. I really see the reader’s articles, the articles in that prospectus. I see all of them.” (P1)

• “Life without glasses is really comfortable. When I wake up in the morning, I don’t look for glasses.” (P4)

• “I never thought I would be able to read a book from this distance in <24 hours after surgery.” (P10)

• “I expected clear results within a few days, but months later my vision is still not as good as I hoped… I feel I was rushed into the surgery without enough time or information to think it through.” (P6)

3.2. Night vision problems and dysphotopsia

Both doctors and patients acknowledge halos, glare, and other night vision difficulties as common postoperative issues. Clinicians emphasize that these dysphotopsias generally improve as neural adaptation occurs over several months. Patients describe initial halos, haze, and reduced night vision quality, though many note gradual relief over time. Variations in lens design (e.g., ringed vs flat lenses) may influence glare severity. Ultimately, both perspectives agree these issues typically lessen but recognize that adaptation times differ among individuals.

3.2.1. Doctor perspectives

• “With these lenses, there is some distortion and glare in the lights at night; this is natural. It results in 1 or 2 halos around the lights or some star-like reflections.” (D2)

• “Light scattering may occur at night. It usually disappears gradually between 3 months and 1 year.” (D4)

• “Some patients are uncomfortable with this light scattering, but 90% to 95% of patients get used to it.” (D37)

3.2.2. Patient perspectives

• “The lights on the electricity poles appear as large, colorful halos, creating a striking visual effect.” (P1)

• “For car headlights... after 6 months, the severity decreases by about 70%.” (P2)

• “At night, when driving, I feel my vision is slightly diminished, and the lamp glares make it harder to recognize faces.” (P3)

• “The halos have actually decreased compared to the first day.” (P4)

• “I find myself squinting at the phone’s light, clearly sensing increased sensitivity to headlights at night.” (P6)

• “I don’t see any halos or rings around the lights in the evening.” (P8)

3.3. The importance of individualized lens selection

Optimal outcomes hinge on tailoring lens choices to each patient’s ocular characteristics, lifestyle, and visual tasks. Both sides underscore the necessity of careful evaluation and personalized recommendations that align with occupational requirements and personal expectations.

3.3.1. Doctor perspectives

• “We decide which lens is more suitable by talking together according to the patient’s life conditions and expectations.” (D2)

• “Your eye structure is very important... …The doctor will make the best choice accordingly.” (D3)

• “It is not right to set general rules for every patient; the decision must be individualized.” (D19)

3.3.2. Patient perspectives

• “It is very important to choose a lens and a surgeon appropriate to your age, profession, and eye numbers.” (P3)

• “You should choose your doctor carefully, research the lenses thoroughly... these decisions are important.” (P10)

3.4. Technological advances in lenses

While physicians highlight ongoing innovations, such as trifocal and EDOF lenses, ringless “edflex” options, and even AI-assisted decision-making, patients tend to focus on more practical aspects like brand quality and lens configuration. However, patient narratives sometimes reveal misunderstandings or oversimplifications of these technological advancements, underscoring the importance of clear communication during consultations. Despite these differences, both perspectives agree that cutting-edge technology, when combined with meticulous individualization, is essential for achieving improved and more satisfying visual outcomes.

3.4.1. Doctor perspectives

• “Multifocal lenses, also known as trifocal lenses, have evolved significantly over the past 18 years.” (D37)

• “There are some high-tech smart lens types... EDOF lenses that do not cause night glare.” (D2)

• “Artificial intelligence provides data indicating potential risks and guiding adjustments.” (D5)

• “New technology ring-less edflex lenses have been developed for patients who have difficulty adapting to trifocal lenses.” (D33)

3.4.2. Patient perspectives

• “Now the first one, friends. You should definitely go to a doctor first and decide which lens needs to be fitted. The doctor will already explain it to you, but I’ll tell you as well. There is only this: a ringed lens and a trifocal flat lens. The ringed lens is also trifocal, and the flat one has a smooth upper segment and is normally a trifocal lens.” (P7) (Note: The patient’s explanation appears to reflect a misunderstanding, as no such classification of “ringed” and “flat” trifocal lenses exists.)

• “You can see that lenses differ significantly. Brand and quality really matter.” (P8)

3.5. Postoperative adaptation and management

Physicians provide structured timelines for postoperative adjustment, indicating that full comfort and stable vision may take several months. Patients describe varied recovery experiences: while some quickly regain near-normal functionality, others encounter persistent haze or mild discomfort. Nonetheless, both doctors and patients agree that patience, adherence to medication protocols, and careful self-care foster a smoother adaptation process.

3.5.1. Doctor perspectives

• “In about 3 to 6 months, most patients no longer feel these issues.” (D2)

• “Adaptation develops over time... it can be difficult for the first 6 months to a year.” (D3)

• “These issues fade with time, but we always inform patients from the start.” (D28)

3.5.2. Patient perspectives

• “After 3 days or a week or 10 days, if I can’t see well, it is still too early.” (P2)

• “After 6 months, the big halos were gone.” (P1)

• “You need to allow time for your brain and the lens to adjust after surgery.” (P2)

• “There’s still a slight haze in my left eye, but it is improving day by day.” (P3)

• “I’m satisfied now, but it has only been a month, and it is still part of the healing process.” (P8)

3.6. Ethical issues and patient information

Clinicians point out that patients need honest communication about potential outcomes, risks, and realistic expectations. Some patients feel insufficiently informed or believe their concerns were dismissed, leading to dissatisfaction and mistrust. Conversely, 1 patient acknowledges having autonomy in the final decision. Both parties suggest that transparent and ethical communication is integral to building trust and optimizing patient satisfaction.

3.6.1. Doctor perspectives

• “It is very important to clarify expectations about smart lenses and explain their disadvantages.” (D16)

• “Explaining the risks and benefits of multifocal lenses is an ethical responsibility.” (D31)

• “We tell patients everything from the beginning. If they don’t know, they may become overly worried.” (D28)

3.6.2. Patient perspectives

• “Patients should be well-informed about possible side effects and how these lenses differ from natural vision.” (P1)

• “Some patients are very unhappy after surgery, so setting realistic expectations is important.” (P4)

• “I wasn’t informed about potential risks or technique limitations… When I expressed my concerns, they simply said, ‘Your vision is fine,’ ignoring my real issues.” (P6)

• “Ultimately, it is your choice. No one forces you. It is entirely up to you.” (P5)

3.7. Surgical procedure’s practical aspects

Both clinicians and patients describe the surgery as rapid, relatively painless, and surprisingly comfortable, despite doctors noting the complexity and skill required. The short procedure duration, minimal discomfort, and swift partial recovery reported by patients confirm the effectiveness of refined techniques and advanced lens technologies.

3.7.1. Doctor perspectives

• “This is a non-painful, comfortable surgery for the patient with no major issues.” (D3)

• “For a normal cataract or a healthy eye, each eye takes about 8 to 10 minutes.” (D4)

• “Although short, the surgery is among the most complex in ophthalmology.” (D17)

3.7.2. Patient perspectives

• “It really goes into your eye, takes 5 minutes, and it is done very quickly.” (P1)

• “The surgery itself went smoothly, and I didn’t feel any significant pain during or after.” (P3)

4. Discussion

The present study provides a structured comparative analysis of patient- and doctor-produced YouTube videos addressing advanced IOL surgeries. The findings provide valuable insights into the intersection of clinical expertise and patient experiences, highlighting key areas of convergence and divergence in perspectives. While physicians articulate the procedural intricacies, technological advancements, and the necessity of individualized lens selection, patients highlight comfort, visual outcomes, and practical adaptations in their everyday lives. However, physician narratives often emphasize structured timelines and predictable outcomes, whereas patient experiences underline variability and occasional communication gaps, suggesting a nuanced divergence between clinical expectations and patient reality. These insights are critical for enhancing patient-centered communication, expectation management, and the effective integration of emerging technologies in ophthalmic care.

Both clinicians and patients concur that proper counseling and setting realistic expectations are pivotal for achieving favorable outcomes. Similar to earlier reports, dissatisfaction often arises when initial hopes are not fully met or when preoperative guidance is limited, reaffirming the significance of comprehensive patient education.^[5,14,15] Dysphotopsia phenomena (halos, glare, and night vision challenges) are acknowledged by both parties, consistent with prior studies noting these as common but generally transient postoperative experiences.^[6,7] Nevertheless, patient narratives reveal a broader range of adaptation experiences, indicating that physicians may underestimate the subjective severity and duration of these phenomena in some patients. The interplay between careful lens selection and postoperative adaptability highlights that no single lens type or approach uniformly satisfies all patients, mirroring contemporary calls for personalized surgical planning.^[16]

Beyond these clinical aspects, the incorporation of social media as a medium for medical information and personal testimony emerges as a critical dimension.^[10,17] This study focuses on YouTube, a platform known for its educational potential and patient engagement, and reveals that patient-generated videos reached a broader audience beyond their subscriber base, indicating a heightened public interest in genuine personal narratives rather than solely professional content. While physicians typically emphasize advanced technologies and procedural details, patient-generated content prioritizes practical daily implications, occasionally including misconceptions about lens technologies. This divergence underscores the importance of clear and tailored patient communication during clinical encounters. These user experiences (ranging from highly satisfied to cautiously critical) can shape patient perceptions even before formal clinical evaluation, echoing the notion that online health content influences patient decision-making and satisfaction.^[18]

From a clinical and healthcare systems perspective, these insights matter not only to ophthalmologists but also to general practitioners and family physicians who frequently encounter patient questions long before specialist referral. Given that patients may have limited access to direct ophthalmological consultation, the role of primary care providers becomes central.^[19,20] By understanding prevalent patient concerns, first-contact physicians can provide informed preliminary counseling, mitigate unrealistic expectations, and guide patients toward the specialized advice they will eventually require.^[19] Integrating insights gleaned from user-generated video narratives thus enhances the first-line clinical approach, contributing to more patient-centered care.

This study has several limitations. Its focus on Turkish-language YouTube videos may restrict the generalizability of findings to other linguistic or cultural contexts. Additionally, the lack of direct patient interaction and clinical validation of reported outcomes limits the depth of analysis. One notable limitation of this study is the relatively small number of patient-generated videos compared to doctor-generated ones, despite efforts to include as many relevant patient videos as possible. This disparity reflects the limited availability of patient narratives on YouTube in this context. Future research could look into how online health stories differ across cultures, assess how shared content affects patients’ choices, and offer deeper understanding by comparing personal stories with clinical results through direct interactions with patients.

5. Conclusion

In summary, this study highlights that matching the skills and advice of doctors with the actual experiences and hopes shared by patients online could improve the quality and satisfaction of advanced IOL procedures. The findings call for increased focus on transparent communication, individualized lens selection, and proactive expectation management. Clinicians should proactively address patient expectations by clearly communicating potential postoperative experiences such as dysphotopsia and varying adaptation timelines. Patients, in turn, could benefit significantly from detailed, personalized discussions about lens options, including realistic outcome scenarios and recovery processes. By including stories and experiences shared by patients in their discussions, doctors can reduce confusion, improve patient satisfaction, and help patients make better choices about multifocal IOL surgeries. As social media’s role in health communication continues to grow, leveraging these digital narratives may refine clinical practices and patient education, ensuring that evolving IOL technologies not only excel in surgical outcomes but also resonate with patient aspirations and lived experiences.

Author contributions

Conceptualization: Ersan Gürsoy.

Data curation: Nurcan Gürsoy, Ersan Gürsoy.

Formal analysis: Nurcan Gürsoy, Ersan Gürsoy.

Investigation: Nurcan Gürsoy.

Methodology: Ersan Gürsoy.

Resources: Ersan Gürsoy.

Software: Ersan Gürsoy.

Supervision: Ersan Gürsoy.

Writing – original draft: Nurcan Gürsoy, Ersan Gürsoy.

Writing – review & editing: Nurcan Gürsoy, Ersan Gürsoy.