Is it time to increase use of bilateral cataract surgery?

Wider adoption of bilateral cataract surgery in Ireland was recommended at this year’s Irish College of Ophthalmologists (ICO) Annual Conference in Kilkenny.

Cataract surgery has traditionally been performed sequentially, with weeks between each eye’s procedure. The uptake of immediate sequential bilateral cataract surgery (ISBCS), where cataract surgery is performed on both eyes during the same surgical session, is increasing internationally.

This is due to potential benefits such as reduced hospital visits, faster visual recovery, and cost-effectiveness.

However, the procedure is still not widely performed in Ireland.

The topic generated a lot of discussion among ICO members as to whether this is a model to adopt at a national level.

While cataract waiting lists have improved in Ireland in recent years, thanks largely to the ongoing introduction of dedicated cataract theatres, demand is also increasing.

Demand for cataract surgery in Ireland is projected to rise by 50 per cent by 2035, given the ageing and growing population.

Dr Robert McGrath, Ophthalmology Department, Mater Misericordiae University Hospital (MMUH), Dublin, presented a paper on the experience of implementing a model of ISBCS in the MMUH. 

Meeting the increasing demand for cataract surgery necessitates redesigning theatre processes to maximise output and efficiency, without compromising patient care, he noted.

“ISBCS has been well described in other countries to provide excellent patient outcomes and faster recovery while increasing theatre efficiency.”

The MMUH team prospectively gathered data on the first 200 consecutive patients (400 consecutive eyes) undergoing ISBCS under local anaesthesia in the hospital. In total, 58 per cent of the patients were female with a mean age of 72.3 years.

The ISBCS model saved one theatre visit and one post-operative clinic visit each per patient, cutting the total patient journey from five visits to three. The average distance commuted by patients to the hospital was 42km and the ISBCS model cumulatively saved patients ~30,000km of travel and six tonnes of CO² emissions. Almost all (98 per cent) of the ISBCS procedures were performed with topical or intracameral anaesthesia only. In terms of clinical outcomes, mean visual acuity improved from 0.42 logMAR to 0.16 logMAR (p<0.00001), 94.4 per cent of eyes were >0.3 logMAR and every patient had at least one eye >0.3 logMAR at one month. Furthermore, 98.1 per cent of eyes were <1D from refractive target and 81.5 per cent of eyes were <0.5D from refractive target.

Regarding complications, there were no cases of bilateral simultaneous endophthalmitis and only one case of bilateral postoperative cystoid macular oedema.

The mean turnover time between patients was 13.8 minutes and the mean turnover time between eyes was 3.6 minutes. All theatre lists finished on or ahead of time and the ISBCS model has to date allowed lists of 10 phacoemulsification procedures to be completed in under three hours.

The MMUH study concluded that ISBCS represents a safe, effective, and highly efficient means to optimise theatre efficiency, provides high-quality patient care, and helps meet growing population demand.

ISBCS has been successfully implemented into MMUH practice and could be adopted in other units across Ireland, Dr McGrath said.