For some, the very mention of immediate sequential bilateral cataract surgery (ISBCS) or cataract surgery to both eyes on the same day would invoke a strong gut reaction and vehement objection. Although at one time there was good reason for this, advances in technology in cataract surgery have been dramatic. We now perform cataract surgery under topical anaesthesia through ever smaller corneal wounds that allow for more predictable refractive outcomes, quicker visual recovery, and quicker refractive stabilisation. The bulk of cataract operations are now done as a day-case procedure. Cataract surgery nowadays has a generally very low rate of complications, and we would argue that ISBCS has now become a viable and safe alternative. We have learnt from LASIK that bilateral simultaneous surgery is a viable option if the complication rate is low and the visual recovery is rapid.

Few surgeons currently offer ISBCS routinely, but more offer ISBCS in special situations in cases where general anaesthesia is required to complete the cataract operations safely, and where repeated general anaesthesia is undesirable because of complex medical problems, or in patients with significant disabilities or handicap, where it is performed to minimise the distress for the patient.

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