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Bilateral cataract surgery could follow the same path as LASIK
Bilateral sequential same-day eye surgery is not new to ophthalmology.
 Richard L. Lindstrom |
For me and my anterior segment surgeon colleagues, LASIK is the most common example, and the majority of us worldwide have adopted bilateral same-day surgery. The history of our transition to this practice pattern may shed some light on the bilateral same-day cataract surgery controversy.
I started with PRK in 1988 in the U.S. clinical trials. Visual recovery was slow, complication rates were not well- understood, and complication treatment regimens and prognosis were still inconsistent.
Twenty years later, bilateral sequential same-day LASIK surgery is standard practice for me and the majority of the world’s refractive surgeons. This transition occurred because we surgeons firmly believe it is in the best interests of our patients.
The analysis of what is in the patients’ best interests usually condenses to an honest evaluation of the risk-to-benefit ratio. In a prospective study evaluating outcomes and patient satisfaction comparing bilateral same-day LASIK surgery to unilateral staged LASIK surgery performed 1 to 4 weeks apart, we found no increase in risk and a significant increase in patient satisfaction, tipping the scale in favor of treating both eyes the same day.
So what about cataract surgery? Is the procedure so safe and so predictable that it is clearly in the patients’ best interests to routinely perform bilateral sequential same-day surgery? For me, the answer remains: No, not as a routine.
I do perform bilateral same-day sequential cataract surgery in select cases, primarily in those requiring general anesthesia. I believe the risks and morbidity of subjecting a patient to two general anesthetics outweigh the risk of removing both cataracts treated as separate procedures with a totally separate prep and instrument set and performing the procedure as though we were treating two different patients.
My outcomes with this approach have been universally positive, and I have no horror stories to report. Still, I, along with 95% of my colleagues worldwide, am not yet ready to recommend bilateral sequential same-day cataract surgery for the routine patient. The sight-threatening complications remain too frequent, too devastating and often respond poorly to treatment.
I find the outcome in the first eye often significantly impacts my surgery timing, approach and especially IOL selection for the second eye surgery.
Still, I support those brave enough to pioneer in this area, as an ever tougher reimbursement environment, increasing demand for cataract surgery with an aging population, a declining cohort of skilled cataract surgeons per thousand patients and significant societal pressure to increase our hourly productivity may force us in this direction.