‘Bilateral same-day cataract surgery should routinely be offered to patients’ – No

Ophthalmologists have been debating the pros and cons of same-day bilateral cataract surgery for decades, but it is only recently that immediate sequential cataract surgery (ISCS) has been gaining popularity.^{1, 2} There have been a growing number of peer-reviewed publications addressing the issue, an International Society of Bilateral Cataract Surgeons established, and guidance regarding this included in the Royal College of Ophthalmologists Cataract Surgery Guidelines.^{1, 3, 4} Interest in ISCS has been fuelled by improvements in surgical outcomes and studies demonstrating the economic benefits of operating on both eyes on the same day.⁵ With appropriate case selection⁶ and precautions against endophthalmitis and refractive surprise, ISCS can result in excellent outcomes and high levels of patient satisfaction.^{1, 7, 8}

Despite growing interest, in most countries ISCS remains the exception rather than the rule, and it is our view that it should remain this way and that bilateral cataract surgery should not be routinely offered to patients. The arguments in favour of same-day bilateral surgery are primarily related to convenience and economy,⁹ but these benefits are outweighed in most circumstances by the small but devastating risk of bilateral blindness due to a complication of surgery.

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