Delayed Sequential Bilateral Cataract Surgery Tied to Slightly Better Visual Outcome

By David Douglas

July 15, 2021

NEW YORK (Reuters Health) - Patients who undergo cataract surgery in both eyes on the same day (immediate sequential bilateral cataract surgery or ISBCS) have poorer refractive outcomes than those who have it on separate days (delayed sequential bilateral cataract surgery, DSBCS), according to a new study.

"We used the IRIS Registry data to analyze outcomes after bilateral cataract surgery to determine if there were any differences in visual acuity outcomes between either within 2 weeks or with a longer interval (up to 90 days) between surgeries," Dr. Cecilia S. Lee of the University of Washington, in Seattle, told Reuters Health by email.

She and her colleagues analyzed data on more than 1.8 million patients who underwent bilateral cataract surgery; 37.5% of the patients were male. Based on the delay, in days, between the first and second operation, the patients were divided into three groups (DSBCS-90, DSBCS-14, and ISBCS groups). All had visual-acuity data available.

A total of 44,525 patients underwent ISBCS, 897,469 DSBCS-14 and 882,202 DSBCS-90, the researchers report in JAMA Ophthalmology.

Compared with those undergoing DSBCS-90, Research in Sight Registry uncorrected visual acuities were lower for patients undergoing ISBCS by 2.79 letters. For best-corrected visual acuity, the corresponding value was 1.64 letters. Patients who underwent DSBCS-14 had slightly better outcomes, at 0.41 and 0.89 letters, respectively.

After controlling for age, preexisting eye disease and demographic factors, patients who had ISBCS had slightly worse visual acuity (equivalent of 1-2 letters on the ETDRS - Early Treatment Diabetic Retinopathy Study - chart) than DSBCS patients, and this difference was statistically significant, said Dr. Lee.

However, she added, "The sample size was very large, and therefore this small difference may not be clinically relevant for most patients. However, we found that certain risk factors were associated with worse visual-acuity outcomes after bilateral cataract surgery, notably preexisting diabetic retinopathy, Asian and African American race, and Medicaid enrollment. So, although the outcome differences were very small between ISBCS and DSBCS, some physicians and patients may want to take timing of the surgery into consideration if there are other risk factors for worse visual acuity after bilateral cataract surgery."

In an accompanying editorial, Drs. Fasika A. Woreta and Oliver D. Schein of Johns Hopkins University School of Medicine, in Baltimore, Maryland, caution, "The differences between groups were so small that they could easily have been caused by confounding factors not otherwise accounted for."

Nevertheless, they point out, "We should seek to understand individual patient preferences regarding ISBCS instead of assuming them a priori or simply providing our own perspectives."

SOURCE: and JAMA Ophthalmology, online July 1, 2021.