“Cataracts?”

In general, we don’t do both eyes at the same time. Except when the risk anesthesia is higher than the risk of infection. This occurs rarely. Twice in thirty years. Once when the patient was a newborn with cataract where the risk of death was 40 percent with anesthesia. Why would you do the surgery and take the risk of infection and loss of vision in both eyes at the same time?

Dr. LMJ

Some HMO's are doing that, but I do not think that it is in your best interest. For example, if you get an infection in 1 eye (which is very serious), you might get the infection in both eyes (which could be disastrous). Therefore, I would not do that. The same goes for other potential complications.

Ronald N. Gaster, MD, FACS

Most physicians do not offer this for a variety of reasons: if something goes wrong with one eye, it would be terrible for it to happen to both eyes, insurance does not pay for both eyes same day, etc. Kaiser permanente system does offer this and you may be able to find some places that offer this, but for most doctors, it is a non starter financially.

Frank Cao

A small possibility of infection or other complication means one eye at a time is prudent. SO

The short answer is that the risk of endophthalmitis following cataract surgery is a little over 1/1000. Many patients with this type of infection suffer permanent vision loss. If both eyes are operated on the same day, there's an obvious risk of permanent vision loss in both eyes. The risk can be lowered by treating both surgeries as a single operation, utilizing a separate prep, drape, and instrumentation. At some point, I expect that Medicare will determine that the risk is worth the decrease in cost and convenience, but at this point it's just not done in the USA.

Stephen Hamilton, MD

There are a few brave surgeons and patients doing this. Certainly there are other surgeries wherein both eyes are operated on the same day, such as strabismus (eye muscle) surgery, blepharoplasty (eyelid surgery), and some others. Although rare, the most dreaded complication of cataract surgery is endophthalmitis (infection in the eye), which may lead to blindness and sometimes loss of the eye. The thought of having this occur to both eyes is the primary reason the two eyes are not operated on the same day, but although cataract surgery is safe and effective, there is about a 2% incidence of other complications, but if a complication occurs following surgery in one eye, there is a much higher likelihood of the same complication in the other eye. So, in most cases, one eye is operated and the second eye is planned for surgery days to weeks later, to allow the surgeon and patient to feel reasonably assured that there is no significant complication of the first surgery, before the second is done. On the other hand, in many cases, “standard of care” evolves in part by what is dictated by Medicare or Insurance Companies; as soon as the “payers” determine that is less expensive to have patients have both eyes operated on the same day, they will require it, and that will become the new “standard of care,” even though it may not be the safest care.

Traditionally eye doctors do one eye at a time. However i had both mine done at the same time, one after another. Your eyes are not covered and you can see almost immediately. Only concern is you have to be very careful and clean and hygienic to prevent infections on the eye for 2 weeks.

Most patients will see worse for a day or so before the cornea clears and vision improves, so unless your cataract limits your vision to less than 20/100 in both eyes, you’ll do better to wait until first operated eye has recovered to your satisfaction.

Currently not the standard if care. Some university programs and Kaiser Permanente are running ISBCS - immediate sequential bilateral cataract surgery.

Timely question as this is being considered currently! The reason probably lies in several planes. Unfortunately lengthy answer.

First, separating the surgeries insures that unlikely contamination and infection won’t afflict both eyes. Theoretically, same day surgery makes such an event more likely! Second, occasionally, the vision doesn’t recover for a day or so after surgery, leaving a patient at risk of reduced function in the operative eye. If both eyes are done sequentially in the same day and similarly affected, there is a risk of overall poor function for a finite period! This is basically risk averse behavior. Historically, it was thought best to allow one eye to recover completely before doing the other and this became a “standard of practice”. Physicians, like everyone else, are often resistant to change! Fourth, the surgeon may learn from the first surgery and thereby have an opportunity to adapt the second surgery to refine the outcome!

And last, you knew I get to this, is the fact that insurance companies like Medicare will only pay 50% of the standard fee for a second or subsequent surgery performed at the same surgical setting! Margins are tight these days and neither surgeons nor surgery facilities can really afford that hit! Cataract surgery depends on expensive technology, and regulatory compliance is adding to costs while payments are being reduced.

The push to bilateral same day cataract surgery is being motivated by trends in other countries where it is more commonly done!

Hope this answers your question!

Glenn N. Pomerance, M.D.
Chattanooga, TN