Cataract Surgery on Both Eyes: Is It Done Together in India?
If you have been diagnosed with cataracts in both eyes, you might find yourself facing a practical question: can both eyes be operated on at the same time? The idea is certainly appealing.
One surgery day, one recovery period, and a faster return to a life of clear vision. For decades, the standard approach in India and worldwide has been to operate on one eye, wait for it to heal, and then schedule the second eye.
This method, known as delayed sequential bilateral cataract surgery, is time-tested and prioritises safety above all else.
However, with advancements in surgical techniques and sterilisation protocols, the conversation around performing the procedure on both eyes in a single session is gaining momentum.
This procedure, called Immediately Sequential Bilateral Cataract Surgery (ISBCS), is becoming a viable option for certain patients in India.
This guide explores the benefits, risks, and crucial factors you need to consider before deciding if operating on both eyes together is right for you.
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Ophthalmologist/ Eye Surgeon 13+ Years Exp
MBBS, MS – Ophthalmology
TSMC- TSMC/FMR/05251 (2018)
CONDITION
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The Traditional Approach: One Eye at a Time
The conventional practice of separating the two surgeries by a few days or weeks is rooted in a fundamental principle: protecting the patient.
The primary concern has always been the extremely rare but devastating risk of a simultaneous infection in both eyes (bilateral endophthalmitis), which could lead to catastrophic vision loss.
By operating on one eye and allowing it to heal, surgeons can confirm a successful outcome before proceeding with the second eye.
This sequential method provides a crucial safety buffer, ensuring that even in the worst-case scenario, the patient retains vision in one eye.
This approach has served patients well for decades and remains the most common practice in India.
When Might Simultaneous Surgery Be an Option?
While the one-at-a-time approach is the default, there are specific situations where ISBCS may be considered by experienced surgeons in India, particularly for patients who face logistical or medical challenges.
- Patients Requiring General Anaesthesia: Some individuals, due to anxiety, medical conditions (like Parkinson’s disease or dementia), or developmental disabilities, cannot remain still during surgery under local anaesthesia. Subjecting them to general anaesthesia twice carries its own set of risks, making a single surgical session a safer overall option.
- Logistical Hardships: For patients who travel long distances from rural areas to urban hospitals for treatment, a single visit can save significant time, travel expenses, and the stress of arranging accommodation and accompaniment twice.
- High-Risk Occupations: Professionals who need rapid visual rehabilitation to return to work, such as pilots or commercial drivers, may be candidates if they meet strict health criteria.
- Patients with High Refractive Errors: Individuals with very high spectacle power in both eyes can experience significant visual imbalance (anisometropia) after the first surgery, leading to dizziness and difficulty with depth perception. ISBCS eliminates this uncomfortable interim period.
The Benefits of Operating on Both Eyes Together
The advantages of ISBCS are primarily centred on convenience and faster visual recovery, which can have a significant impact on a patient’s quality of life.
Faster Visual Rehabilitation
The most compelling benefit is the immediate restoration of balanced, binocular vision. Patients avoid the awkward phase of having one clear eye and one blurry eye, which can interfere with depth perception and daily activities.
Reduced Costs and Logistics
A single surgery means:
- Fewer trips to the hospital, saving on travel and accommodation.
- Less time off work for both the patient and their caregiver.
- Potentially lower overall costs related to hospital visits and consumables.
Greater Convenience
One set of pre-operative preparations, one surgical event, and one consolidated recovery period simplifies the entire process. This is especially helpful for elderly patients who rely on family members for support.
Risks and Challenges of Simultaneous Surgery
Despite its benefits, ISBCS is not undertaken lightly. The risks, though minimal in a modern setting, must be carefully weighed.
The Risk of Bilateral Infection
This is the single most significant concern. Although the risk of infection in one eye (endophthalmitis) is already extremely low (less than 0.05%), the possibility of it happening in both eyes at once is the primary reason for caution. To mitigate this, hospitals performing ISBCS must follow a strict protocol:
- Treating each eye as a completely separate surgery.
- Using different sets of sterile instruments, drapes, and solutions for each eye.
- Surgeons must re-scrub and change gloves between operating on the first and second eye.
Post-Operative Visual Surprise
If there is an unexpected refractive outcome (meaning the lens power is not perfect), it would affect both eyes simultaneously. With sequential surgery, the outcome of the first eye can be used to fine-tune the lens choice for the second eye.
Inability to Assess the First Eye’s Outcome
The surgeon loses the opportunity to see how the first eye responds to a particular type of intraocular lens (IOL). For example, if a patient finds the glare from a multifocal lens bothersome in the first eye, they could opt for a different lens in the second. This option is lost with ISBCS.
Factors to Consider Before Making a Decision
The choice between single-eye and bilateral surgery is a personal one, made in close consultation with your surgeon.
Here are the key factors to discuss:
- Your Overall Health: Do you have any conditions, like severe diabetes, that could increase surgical risk or slow down healing? Healthy patients are better candidates for ISBCS.
- The Surgeon’s and Hospital’s Experience: Does your surgeon regularly perform ISBCS? Does the hospital have strict, verifiable protocols in place for bilateral procedures? Do not hesitate to ask about their experience and safety measures.
- Your Lifestyle and Needs: Do you face significant logistical hurdles that make two surgeries difficult? Is rapid visual recovery critical for your job or personal life?
- Your Psychological Comfort: Are you comfortable with the slightly elevated, albeit still minuscule, risk profile of a bilateral procedure? Peace of mind is an important factor.
5.Cost and Insurance: Check if your health insurance policy has any specific clauses regarding simultaneous bilateral surgery.
Conclusion: A Decision Made with Your Surgeon
The possibility of having cataract surgery on both eyes in a single session is a testament to the safety and precision of modern ophthalmology in India. For the right candidate, ISBCS offers a faster, more convenient path to clear vision.
However, it is not a one-size-fits-all solution. The traditional, sequential approach remains the gold standard for a reason: it places an absolute premium on safety.
The final decision rests on a careful and honest conversation with an experienced ophthalmologist who can weigh the unique aspects of your eye health, general health, and lifestyle needs against the benefits and risks of each approach.
By working together, you can choose the path that will best restore your sight safely and effectively.
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AUTHOR
Ophthalmologist/ Eye Surgeon 13+ Years Exp
MBBS, MS – Ophthalmology
TSMC- TSMC/FMR/05251 (2018)
CONDITION
CALL US 24/7 FOR ANY HELP
GET IN TOUCH ON
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