Immediate sequential bilateral cataract surgery: surgeon preferences and concerns

Objective: We surveyed cataract surgeons to gain insight into their perceptions of and attitudes about immediate sequential bilateral cataract surgery (ISBCS).

Design: Cross-sectional.

Participants: All active cataract surgeons in Kaiser Permanente Northern California in 2016.

Methods: Online survey that asked cataract surgeons why they did or did not perform ISBCS, their interest in offering ISBCS, concerns about the procedure, and desired supports.

Results: Of the 165 active cataract surgeons, 107 (65%) participated in the survey, of whom 92 (86%) responded that they currently practiced ISBCS and 15 (14%) reported that they did not. For ISBCS surgeons, patient convenience (95%) and patient request (91%) were the top reasons for performing the procedure. For surgeons who do not perform ISBCS, the most commonly cited concerns were not having the postoperative refractive outcome from the first eye to guide intraocular lens selection in the second eye (80%) and risk of bilateral vision loss (73%). Among those who do not perform ISBCS, 9 (60%) identified the need for evidence-based patient selection criteria to support a decision to adopt the procedure. In addition, many surgeons in both groups wanted streamlined patient education materials and established protocols.

Conclusion: Patient centeredness is a key construct of contemporary health care delivery, and in an era of low complication risk, many patients request ISBCS; the number of these surgeries has increased. In our capitated health care system, the great majority of surgeons perform ISBCS for the convenience of their patients. Providing surgeons with guidelines and tools to support ISBCS likely would increase adoption.