Can You Have Cataract Surgery In Both Eyes At The Same Time?
Wouldn’t it be nice to be able to get both eyes corrected with cataract surgery at the same time? Sure it would! Only having one surgery is much better than having two surgeries. So how come having cataract surgery on both eyes at the same time isn’t more popular than it is?
Having cataract surgery in both eyes at the same time allows for less inconvenient visits and improve vision recovery. While there are some concerns, the biggest barrier to having bilateral cataract surgery is more of an insurance one than a medical one.
But as the medical landscape changes, having both eyes done at the same time may become more and more routine. There are some good benefits.
Why Get Both Eyes Done At The Same Time?
There are some key reasons why having bilateral cataract surgery is appealing. You probably already thought about some of these yourself as you were wondering if it were possible.
Who here likes to visit their doctor? Ok, its not THAT bad visiting your eye doctor. But making your appointment means that you have to take time off from work or it just simply takes up time that you could be doing something else more enjoyable instead. In addition, driving to your appointment eats up even more time (and gas).
But you do it because appointments are necessary after cataract surgery. While you can monitor for things such as blurry vision yourself at home, certain things such as checking the eye pressure and for inflammation in the eye can only be done in the office.
After cataract surgery, this typically means a 1 day, a 1 week and a 1 month appointment at minimum.
So what happens if you get both eyes done on separate days? You end up having a near doubling of your appointments. Not only do you have a second surgery date, but you also have a second 1 day and 1 week appointment (if the surgeries are close enough together than the 1 month can be combined). A lot more appointments! Extra appointments that you won’t need if both cataract surgeries are done at the same time.
Smoother Vision Recovery
But there is another huge benefit to getting both eyes done at the same time: you don’t have to struggle with having one eye corrected while the other still has a cataract.
Once a cataract is removed, the prescription of the eye changes. For most people, what this typically means is that the vision is optimized for distance vision.
But what do you do if you needed glasses to see prior to cataract surgery? One eye is going to see well without glasses while the unoperated eye will still need glasses. Until the second eye has cataract surgery, it is often a struggle to correct the eyes. Some people pop out the lens of their prescription glasses. Some people decide to just go without glasses and let one eye be blurry.
But even if the vision is corrected, one eye will still be blurry because it has a cataract. This creates differences in vision which can be bothersome.
Having cataract surgery in both eyes at the same time can prevent all that and allow for a quicker vision recovery.
How Is Cataract Surgery On Both Eyes Done
This one seems kinda obvious at first glance. Instead of just doing cataract surgery on one eye, you do it on two instead. But there are far more considerations that go into bilateral cataract surgery.
In fact, bilateral cataract surgery is NOT a single surgery. It is instead treated as TWO separate surgeries (just back to back). Because of this, the proper term for this is “Immediate Sequential Bilateral Cataract Surgery” to represent the fact that it is indeed two different procedures.
And each eye is treated as its own surgery. This means two sets of sterile instruments. Two sets of gowns and drapes. Nothing from the first surgery gets reused for the second surgery.
And this is a key point. By making bilateral cataract surgery two separate surgeries, this essentially doesn’t make bilateral cataract surgery any more risky than a single cataract surgery.
While the risks with cataract surgery are rare, it becomes even more important to avoid these risks when both eyes are being done at the same time.
The Concerns of Bilateral Cataract Surgery
So what’s preventing more surgeons from performing cataract surgery in both eyes at the same time. Well, there are some potential concerns.
Perhaps the biggest concern for having both cataracts removed on the same day is getting an infection that involves both eyes (something known as endophthalmitis).
Infections can cause you to permanently lose vision. Because of this, surgeons care about reducing the risk of infections to be as low as possible. On top of this, if for some reason infections occurred in both eyes and both eyes lost vision, that could be devastating.
This is the main reason that bilateral cataract surgery is treated as two separate surgeries. By keeping the procedures separate, than the risk of infection for one eye is completely independent of the risk of infection for the second eye. Because of this, there is no increased risk of infection in one or both of the eyes after bilateral cataract surgery. And fortunately the infection risk remains low (approximately ~ 1 in 10,000). Could you theoretically still have an infection in both eyes? Yes, but it would be two independent events and be the same risk as having the eyes done on separate days (about 1 in 100 million!)
Calculating The New Lens
The second argument against bilateral cataract surgery is that when cataracts are done on separate days, the final refraction from the first eye can be used to improve the results on the second eye.
After cataract surgery, a new lens is placed within the eye. Remember how most people generally have improved distance vision after cataract surgery? This is because calculations are done prior to surgery to pick the power of the new lens which optimizes vision the most.
But these calculations aren’t perfect. For most people it will be spot on; but for some you can have some remaining prescription after cataract surgery (this risk is increased if you have had prior refractive surgery such as lasik). If you’ve learned from the first eye that the calculation will be off, you can potentially compensate on the second eye. This seems to make sense.
But how big of an effect is it? Within ophthalmology, there is a large database of patient data. This has allowed us to study large amounts of patient data. And there is technically a small benefit to the outcome of the second eye when having cataract surgery on separate days. But this benefit is so small that for all intensive purposes is insignificant in clinical practice.
The Biggest Reason Bilateral Cataract Surgery Isn’t Common
So why isn’t cataract surgery on both eyes at the same time isn’t more common? At least in the United States it comes down to one big factor: Insurance.
The biggest payor of cataract surgery in the United States is Medicare. And the reimbursement from medicare for cataract surgery on the second eye if it is done on the same day as the first is only 50% of the normal reimbursement.
In effect, surgeons are economically penalized for performing bilateral cataract surgery and it makes the economics of performing cataract surgery on both eyes at the same time challenging if not impossible to avoid losing money.
But there are a few unique situations where you can find bilateral cataract surgery being performed.
- Large managed health organizations can actually be more flexible. Because of the integration of health insurance and care, the organizations are free to modify what they do without worrying about changes in reimbursement. Kaiser, for instance, has embraced bilateral cataract surgery as a treatment for its patients.
- Practices that forgo insurance and instead use cash-based pricing for cataract surgery are also free to do as they please as they aren’t hamstrung by how things would be reimbursed.
Having cataract surgery in both eyes at the same time allows for a quicker overall recovery. Less visits and a speedier improvement in vision are a good thing. Because bilateral cataract surgery is really two independent surgeries, the potential concerns end up not being a significant issue. And as the economic barriers are cleared, having both of your cataracts removed in one quick visit may very well become the norm.
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