From the Guidelines
Cataract surgeries in both eyes are typically performed at separate times to ensure optimal outcomes in terms of morbidity, mortality, and quality of life, as supported by the most recent guidelines from 2022 1. This approach is crucial for several safety and practical reasons. The primary concern is to allow the first eye to heal and vision to stabilize before operating on the second eye, which reduces the risk of complications and improves overall outcomes. If any complications occur during or after the first surgery, surgeons can adjust their strategy for the second eye to minimize similar risks. The recovery period between surgeries also provides patients with time to adapt to the changes in their vision and allows for fine-tuning the lens implant selection for the second eye based on the results from the first eye. Furthermore, maintaining one functional eye during the recovery process significantly reduces the risk of temporary bilateral vision impairment, which could substantially impact a patient's independence and ability to perform daily activities. Key considerations include:
- Allowing the first eye to heal before operating on the second eye to minimize complications and improve outcomes, as emphasized in recent ophthalmological guidelines 1.
- The ability to modify the surgical approach for the second eye based on the experience from the first eye.
- Reducing the risk of bilateral vision impairment, which is critical for maintaining patient independence and quality of life.
- The use of prescribed antibiotic and anti-inflammatory eye drops in the operated eye during the recovery period, while the other eye remains unaffected until it is ready for surgery. Given the importance of these factors, the typical recommendation is to wait between 1-4 weeks between surgeries, although this can vary based on individual healing rates, the surgeon's preference, and specific patient circumstances, always prioritizing the best possible outcome in terms of morbidity, mortality, and quality of life 1.
From the Research
Cataract Surgeries in Both Eyes
- Cataract surgeries in both eyes are typically performed at separate times due to various reasons, including reducing the risk of complications and improving patient outcomes 2.
- Performing cataract surgeries in both eyes simultaneously, also known as immediately sequential bilateral cataract surgery (ISBCS), can increase the risk of bilateral endophthalmitis, a serious infection that can lead to vision loss 2.
- ISBCS should be performed with complete aseptic separation of the patient's two procedures to minimize the risk of complications 2.
Reducing Complications and Improving Outcomes
- Studies have shown that performing cataract surgeries in both eyes at separate times can reduce the risk of complications, such as endophthalmitis, and improve patient outcomes 3, 4.
- The use of anti-inflammatory medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can also help reduce the risk of complications and improve patient outcomes 5.
- Patients who undergo cataract surgery in both eyes at separate times may experience less pain, inflammation, and activity interference, and may have better uncorrected distance visual acuity compared to those who undergo ISBCS 3, 4.
Patient Preferences and Outcomes
- Patients who undergo cataract surgery in both eyes at separate times may prefer the dropless treatment regimen, which involves the use of intracameral medications, over the conventional topical therapy regimen 3, 4.
- The dropless treatment regimen has been shown to be as effective as topical eyedrop administration in controlling postoperative pain and inflammation, and may result in less out-of-pocket cost for patients 4.