Fernandes et al.⁽¹⁾ used the Iowa Satisfaction with Anesthesia Scale (ISAS) to measure patient satisfaction after cataract surgery. The ISAS generally is appropriate for cataract surgery and has content validity for monitored anesthesia care^(1-3). Fung et al.⁽⁴⁾ showed that the ISAS can be used to measure patient satisfaction with cataract care under topical local anesthesia and monitored sedation.

However, the three previous studies that assessed the reliability and validity of ISAS were performed in English. There is a clear distinction in English between the somatic “I felt pain” and the emotive “I hurt.” The authors’ Methods section does not state that the study was limited to patients who speak and write English at a 4^th grade level or higher, as applicable. The authors’ Discussion does not mention language. Was the instrument used in English or Portuguese? If Portuguese, what systematic processes were used for translation? What percentage of respondents answered these two questions differently? What was the internal consistency (Cronbach alpha) of the instrument? A Portuguese version of the instrument would be very helpful for future investigations.

In addition, ISAS is copyrighted by Franklin Dexter and the University of Iowa Research Foundation. This is stated in each table of the original paper, throughout the second paper, and in each related table of the Fung et al. paper^(2-4). Performing a web search with either Google or Bing (performed February 14, 2014) using the term “Iowa Satisfaction with Anesthesia Scale” returned the authorization form for use as the first entry. What steps did the authors follow to use ISAS, and what changes do the authors recommend for the authorization process described at www.FranklinDexter.net/FAQ/FAQ_a32.htm.