Should results from the first cataract surgery be used to guide second eye surgery?
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Click here to read the Cover Story, "Surgeons address pros, cons of immediate sequential bilateral cataract surgery."
Advantageous to know outcomes
Is it necessary to have the results from the first cataract surgery to guide our results for the second eye surgery? I answer a qualified yes.
If I am performing cataract surgery on a virgin eye with a traditional monofocal lens and the patient is counseled that they will most likely wear glasses after both eyes are done, then I do not need refractive results from the first eye. However, there are many more examples in which having refractive results from the first eye would be useful.
Cataract surgery, using any type of lens implant, after previous refractive surgery even with today’s modern formulae can benefit from knowing what happened in the first eye for fine-tuning the refractive target of the second eye to avoid a large miss.
With the increasing demands from our premium lens patients for near-perfect results when using presbyopia-correcting lens implants, getting the distance, intermediate and near results from the first eye always helps me target the desired result in the nondominant second eye, whether it be the same refractive target, perhaps some blended vision for better near or even selecting a different lens for the nondominant eye to maximize unaided near vision.
The game changer in the equation may be the Light Adjustable Lens (RxSight), which allows the surgeon to correct astigmatism and fine-tune distance or near vision after cataract surgery is performed. A future multifocal version of this lens will go even further to cutting the cord off of the first eye surgery results. However, even now, the ability to alter the toricity and nearsightedness or farsightedness is limited to a fairly low range, dioptrically speaking.
As the art stands right now, if I were undergoing surgery today, I would want my surgeon to have the advantage of knowing the results from my first eye to help nail down the 20/happy result that I would desire.
Jeffrey Whitman, MD, is an OSN Cataract Surgery Board Member.
Technology decreases margin of error
Modern biometry, keratometry and IOL formulae have decreased the margin of error in our IOL selection process today.
It is rare to see a large refractive surprise, and as such, I do not believe that it is necessary that results from the first cataract surgery be used to guide second eye surgery. In my own clinical practice, I routinely perform surgery 2 weeks apart, although sometimes even closer together, and it is rare to have a postop refraction or other measurement from the first eye surgery be helpful in making any decisions about IOL power in the second eye. We should feel comfortable in relying on modern IOL formulae, but perhaps if there is question or concern over the repeatability or quality of biometry, then one may want to see what happens in the first eye. If an unexpected complication arises in the first eye, delaying the second eye surgery should also be considered to ensure the best outcomes for our patients.
Advancements in lens technology have enabled us to no longer need to rely on the outcomes of the first eye to ensure accuracy in the second eye. The expanded use of Light Adjustable Lenses (RxSight) may also be a valuable addition to our armamentarium to ensure accurate results in both eyes.
Light Adjustable Lenses allow us to customize vision after cataract surgery in both eyes and to adjust and preview vision until it meets a patient’s desires and requirements. This is all possible without the need to rely on the outcome of the first eye surgery.
Preeya K. Gupta, MD, is an OSN Cornea/External Disease Board Member.
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