Most Surgeons Say Immediate Sequential Bilateral Cataract Surgery Should Not Be the Standard of Care

In a survey-based questionnaire, the majority of US-based ophthalmic surgeons indicated that immediate sequential bilateral cataract surgery (ISBCS) should not be the standard of care for routine cataract surgery, according to a report published in the Journal of Ophthalmology. But these opinions are based not on safety concerns about the procedure, but rather reduced reimbursement rates and medicolegal concerns, the report shows.

“Numerous reports in both the US and abroad have demonstrated the safety and efficacy of ISBCS. Safety concerns include risk for bilateral endophthalmitis, bilateral toxic anterior segment syndrome (TASS), and inability to refine lens implant calculations for the fellow eye, but these concerns have largely not been supported by findings in the literature when proper protocols are used,” researchers report.

To evaluate the perspectives of practicing refractive surgeons regarding the implementation of ISBCS in the US, the research team emailed an electronic survey-based questionnaire to all surgeon members of the Refractive Surgery Alliance (RSA). 

The questionnaire included questions on various aspects regarding ISBCS, and the team compared the responses with those from ophthalmic surgeons based in Europe from published reports.

Of 240 US-based surgeon members of the RSA, 107 (44.6%) responded to the questionnaire. One-quarter of participants indicated that they currently perform ISBCS, and 22.5% indicated that they thought ISBCS should be offered as a standard of care for routine cataract surgery. 

The researchers reported that the factors indicated as most important by surgeons who do not perform ISBCS (75/107; 70.1%) were concerns related to medicolegal issues (58.7%) and decreased reimbursement (54.7%). 

They found that 67.2% of surgeons based in Europe (vs 25.2% of US-based surgeons) perform ISBCS (P <.0001).

“The primary limiting factors [to the widespread adoption of ISBCS] are related to medicolegal and reimbursement issues, two reasons unrelated to patient care,” explain the researchers. “Physicians can inform policy-makers regarding the cost savings of ISBCS for the healthcare system while noting that a large decrease in physician reimbursement will inhibit its practice and widespread adoption of ISBCS will mitigate many concerns related to medicolegal issues.”