Surgeons should consider offering immediate sequential bilateral cataract surgery
Immediate sequential bilateral cataract surgery can offer similar vision and safety outcomes when compared with delayed sequential bilateral cataract surgery and is a more cost-effective option for patients and the health care system, according to a speaker at the virtual American Society of Cataract and Refractive Surgery meeting.
“In the COVID era, it is time to adapt and offer ISBCS,” Huck A. Holz, MD, a cornea specialist at Kaiser Permanente Santa Clara Medical Center, said.
Immediate sequential bilateral cataract surgery (ISBCS) results in half as many operating room and office appointments when compared with traditional delayed sequential bilateral cataract surgery (DSBCS). ISBCS requires less personal protective equipment for staff, results in lower clinic costs, and leads to a less crowded practice parking lot and waiting room, he said.
With only one surgery copay and fewer visits, patients also save nearly $203 with the bilateral procedure, he said.
Concerns over ISBCS outcomes, including risk for bilateral endophthalmitis, toxic anterior segment syndrome and refractive surprise, are unfounded by findings in the literature. In a 2011 study in Journal of Cataract and Refractive Surgery, no bilateral endophthalmitis cases were reported in 95,606 patients, Holz said.
With the advent of intracameral antibiotics in 2012, endophthalmitis has been reduced at Kaiser Permanente Santa Clara to just one in 9,000 cases. Additionally, in more than 34,000 cases, no bilateral endophthalmitis has occurred, he said.
For refractive concerns, a retrospective review published in Ophthalmology in 2017 looked at 13,711 DSBCS cases and 3,561 ISBCS cases.
“This showed nearly identical postoperative best corrected visual acuity between the DSBCS and ISBCS eyes. In fact, no statistical difference in best corrected visual acuity, refractive error or rates of emmetropia were found,” Holz said.
Surgical outcomes for ISBCS depend heavily on patient selection. Patients with extreme axial lengths, prior refractive surgery, pathology such as diabetic macular edema, severe blepharitis or a higher risk for endophthalmitis should be avoided for best surgical outcomes, he said.
- Arshinoff SA, et al. J Cataract Refract Surg. 2011;doi:10.1016/j.jcrs.2011.06.036.
- Herrinton LJ, et al. Ophthalmology. 2017;doi:10.1016/j.ophtha.2017.03.034.
- Holz HA. How do I implement a program of bilateral same-day cataract surgery? Presented at: American Society of Cataract and Refractive Surgery meeting; May 16-17, 2020 (virtual meeting).