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Invited Commentary
July 1, 2021

Immediate Sequential Bilateral Cataract Surgery—The Patient Perspective Should Prevail

Author Affiliations
  • 1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Ophthalmol. Published online July 1, 2021. doi:10.1001/jamaophthalmol.2021.2029

Bilateral same-day cataract surgery, also referred to as immediate sequential bilateral cataract surgery (ISBCS), is a controversial topic. In the US, delayed sequential bilateral cataract surgery (DSBSC) is the dominant practice, with a typical waiting period of 1 to 3 weeks between eyes. Although ISBCS has been more accepted in Europe, its use in the US has been slow.

In the study by Owen et al1 in this issue of JAMA Ophthalmology, the authors seek to answer an important question: Is the visual acuity outcome of the second eye cataract operation affected by the length of the interval between the first and second eye cataract operation? The authors report a small decrement in visual acuity for the second eye in the ISBCS group compared with the longer-interval groups. Unfortunately, the observational nature of the Intelligent Research in Sight (IRIS) Registry does not provide confidence in that finding. The differences between groups were so small that they could easily have been caused by confounding factors not otherwise accounted for. The ISBCS group comprised only 2.4% of the sample and was likely chosen based on specific clinical attributes, not to mention differences that might be relevant regarding the surgeons as well. The fact that the first eyes of patients in the ISBCS group also fared worse and that both the first and second eyes of the 1- to 14-day interval patients fared better than those of the 15- to 90-day interval implies that the characteristics of the patients in the various intervals are more likely to be associated with outcome than the interval itself.

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