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Speaker: Now is not time for immediately sequential bilateral cataract surgery
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SAN DIEGO — Immediately sequential bilateral cataract surgery, although not ready to become standard protocol, may be appropriate in specific cases, a speaker told colleagues here.
During a Sunday Summit segment titled “60 Minutes: Controversies in anterior segment surgery” at the American Society of Cataract and Refractive Surgery meeting, Rosa Braga-Mele, MD, FRCSC, OSN Cataract Surgery Board Member, discussed potential upsides and downsides of immediately sequential bilateral cataract surgery vs. delayed sequential bilateral cataract surgery.
Rosa Braga-Mele
“For me, in my humble opinion, not quite yet,” Braga-Mele said. “Doctor reimbursement issues are probably at the top, if we need to be perfectly honest. Potential medical and legal risks of TASS or endophthalmitis, although very, very low, are potentially sight devastating, so we need to take that into consideration.”
One upside of immediately sequential surgery is prompt visual recovery and a rapid return to normal life routines, Braga-Mele said. However, delayed or staged bilateral surgery allows for small adjustments to the second eye based on outcomes in the first eye, she said.
“But now it may not be such a big issue because better calculations are available ... and intraoperative aberrometry could change the playing field with respect to that,” she said.
Medicare reimburses physicians 100% for the first eye and 50% for the second eye if both surgeries are performed at the same time, and some countries offer no reimbursement for the second eye, Braga-Mele said.
“So there’s a profound financial disincentive,” she said.
However, immediately sequential surgery may reduce costs for patients in terms of fewer office visits, lower transportation costs and less time out of work, she said.
Immediately sequential surgery may also be considered for patients who require general anesthesia and those who travel a long distance for surgery, Braga-Mele said.
Immediate second-eye surgery should always be optional for the patient, Braga-Mele said.
“I’m a firm believer in informed consent and patient choice for anything we do,” she said.
Complications encountered with the first eye should be addressed before the second-eye surgery, Braga-Mele said. - by Matt Hasson
Disclosure: Braga-Mele reports no relevant financial disclosures.