Can you have both cataracts done at the same time? More people ask this question now that surgical advances make same-day bilateral cataract surgery accessible to more people, especially when you have access to private London clinics.
Same-day bilateral cataract surgery brings several benefits to patients. Countries like Sweden and Canada already welcome this approach because it helps both patients and healthcare systems work better. Recent studies prove that doing both eyes on the same day works just as well as spacing them apart. Patients who get same-day surgery are just as happy as those who wait 4-6 weeks between eyes. The advantages go beyond just convenience. Patients see better faster, spend less time waiting, and don’t have to deal with one eye being different from the other.
London specialists look at many factors to decide if you’re right for bilateral pseudophakia in one session. The COVID-19 pandemic pushed many European healthcare systems, including some in the UK, to do more same-day procedures. This helps them use their resources better while keeping patients safe. Serious problems like bilateral endophthalmitis are very rare – somewhere between 1 in 250,000 and 1 in 6,250,000 cases.
What London Specialists Say About Bilateral Cataracts
Is bilateral pseudophakia recommended in the UK?
The Royal College of Ophthalmologists (RCO) takes a balanced stance on immediate sequential bilateral cataract surgery (ISBCS). They don’t formally recommend it as standard practise or prohibit it. Specialists believe decisions should be made case by case, with full patient consent and strict surgical protocols.
The RCO noted that ISBCS could reduce risks from multiple hospital visits while streamlining processes during the COVID-19 pandemic. This became vital as departments faced capacity challenges and needed to safely restore cataract services. ISBCS helps cut costs and streamlines operating room efficiency. UK surgeons in NHS settings remain hesitant about adopting it widely. Their careful approach comes from worries about possible bilateral complications, especially endophthalmitis. Large case studies show no safety issues.
How common is same-day surgery in London clinics?
Same-day bilateral cataract surgery isn’t common in NHS settings today. Royal College of Ophthalmologists National Ophthalmology Database shows that less than 0.5% of NHS patients who need cataract surgery in both eyes get ISBCS.
Patients don’t know much about this option. A study showed that even in clinics regularly offering ISBCS, only 40% of patients knew about it. Most learned from clinic staff. Patients stay unaware of same-day surgery unless someone tells them about it.
Patient acceptance varies. A pandemic-era survey showed 45% of patients on NHS cataract surgery waiting lists would choose ISBCS if given the choice. A newer study, published after COVID, found about 36% of patients would try same-day surgery.
What are bilateral cataracts and how are they treated?
Bilateral cataracts means having cataracts in both eyes – a normal part of ageing. Most people develop them in both eyes, though they might progress differently. Specialists treat bilateral cataracts on the same day as two separate procedures. Surgeons and nurses scrub up fresh for each eye. They use new instruments and supplies from different batches to avoid any cross-contamination.
The procedure uses phacoemulsification with intraocular lens (IOL) implantation. Ultrasound technology softens the cloudy lens before doctors remove and replace it with a clear artificial one. Patients get topical anaesthesia and go home the same day.
Comparing Safety: One Eye vs Both Eyes
Safety is the biggest concern when deciding if you can get both cataracts fixed at once. Both doctors and patients wonder if the ease of doing both eyes together is worth any possible risks.
Risk of bilateral complications like endophthalmitis
Endophthalmitis—a serious intraocular inflammation—tops the list of complications doctors worry about after cataract surgery. In spite of that, big studies show that the rates of endophthalmitis are almost the same between same-day surgeries (0.045%) and delayed procedures (0.056%).
The chance of getting endophthalmitis in both eyes with proper sterile technique is tiny—less than 1 in 100 million. A detailed study with over 5.5 million cataract surgeries found zero cases of bilateral endophthalmitis in patients who had same-day procedures.
Your risk of complications depends on several factors. Patients who have diabetes, previous anti-VEGF therapy, or posterior capsular rupture face higher risks. The chance of endophthalmitis jumps from 0.015% in low-risk patients to [16.139%] when posterior capsular rupture happens in high-risk patients.
How surgeons reduce risk with strict protocols
Doctors follow strict rules to keep bilateral pseudophakia risks low. The International Society of Bilateral Cataract Surgeons, Royal College of Ophthalmologists, and Canadian Ophthalmological Society say each eye needs treatment as a separate operation.
These protocols need:
- Full sterile separation between first and second eye procedures
- Different sterilisation cycles for instruments
- No sharing of instruments, drugs or devices
- Different manufacturers’ supplies where possible
- Separate sterile routines for each eye
- Intracameral antibiotics when surgery ends
If problems occur during the first eye surgery, doctors must wait to do the second eye on another day. This careful approach explains why nine cases of bilateral endophthalmitis after same-day procedures happened because people didn’t follow the rules.
Recovery and Visual Outcomes
Cataract surgery recovery varies based on whether you treat one eye or both eyes at once. Your recovery experience can substantially affect how well you function daily and how satisfied you feel with the results.
Visual imbalance after single-eye surgery
Most patients who undergo single-eye cataract surgery develop anisometropia—their eyes have different refractive powers. This creates a vision imbalance between the treated eye and the one still affected by cataracts.
Several challenges emerge from this situation:
- Prismatic effects (anisophoria) that disorient spatial awareness
- Unequal retinal image sizes (aniseikonia) that disrupt depth perception
- Vertical differential prism that might cause diplopia (double vision)
“In practise most patients following original cataract extraction are likely to be symptomatic of anisometropia,” according to Eye News UK research. Vertical phoria often develops when the difference between eyes is more than 2 diopters. This can disrupt fusion and lead to double vision. These visual differences cause much distress and make everyday tasks difficult until doctors treat the second eye—which could take weeks or months.
Faster binocular recovery with same-day surgery
Same-day bilateral cataract surgery (ISBCS) completely eliminates the anisometropia issue. A London specialist puts it simply: “By [performing bilateral surgery], we effectively eliminate the issue of anisometropia post-operatively”.
Same-day surgery shows impressive recovery results. Research shows that 72% of eyes achieved uncorrected distance visual acuity of 20/40 or better by postoperative day one. This number jumped to 92% after one week. Almost every patient (115/116) could see well enough to drive with at least one eye within the first week. Bilateral surgery patients also recover their vision faster overall. They avoid the vision imbalance that typically happens with staged procedures.
Patient-reported outcomes from newer studies
Bilateral procedures earn high satisfaction rates from patients. A complete survey revealed that 96.4% of bilateral surgery patients felt satisfied with their choice. Better yet, 89.7% said they would make the same decision again. This number rose to 91.8% when asked about choosing bilateral surgery during the COVID-19 pandemic.
Studies demonstrate that bilateral surgery improves binocular weighted average visual acuity more than unilateral surgery. This means patients see better during their daily activities. Common temporary challenges after bilateral surgery included sleeping on their back (32.8%), difficulty reading right after surgery (27.7%), and dealing with eye dressings on both eyes (24.6%). Interestingly, 15.4% of patients reported no issues at all after their bilateral procedure.
Cost, Time, and Environmental Impact
The economic and environmental effects of bilateral cataract procedures make a strong case to think about this approach while weighing your surgical options.
Is same-day surgery more cost-effective?
Immediate sequential bilateral cataract surgery (ISBCS) shows clear financial advantages. Studies reveal that ISBCS saves about €403 (£402.64) per patient compared to delayed sequential bilateral cataract surgery (DSBCS). This is a big deal as it means that nationwide implementation could save £27.4 million each year in the UK alone.
Patients save money through reduced travel costs, fewer work absences, and less need for home care support. It also benefits children who need bilateral cataract surgery under general anaesthesia, with societal cost savings of about £2,998.75.
The efficiency gains are remarkable. Operating lists with ISBCS complete eight eyes per four-hour session, while unilateral procedures manage just five eyes. Two separate unilateral operations take 48.71 minutes compared to 42.23 minutes for a single bilateral case—a 13.3% time saving.
Fewer appointments and reduced carbon footprint
The environmental benefits of bilateral procedures are significant. Cataract surgery creates a lot of waste that adds to healthcare’s carbon footprint. Single-use surgical items have a carbon footprint 27 times higher than reusable ones.
Standard UK cataract surgery produces between 130-181.8 kg of CO2-equivalent emissions per procedure. Bilateral surgery helps reduce this through:
- Fewer hospital visits
- Lower transportation emissions
- Less packaging waste
- Fewer disposable surgical supplies
These elements help lower the carbon impact of bilateral procedures. London centres have optimised surgical packs and saved 935 kgCO2e yearly.
Healthcare system efficiency post-COVID
After the pandemic, healthcare systems looked for ways to boost efficiency without sacrificing care quality. Bilateral cataract surgery emerged as an answer, cutting down hospital visits and reducing COVID-19 transmission risks.
The benefits spread throughout the healthcare system. Theatre productivity improves as patient transfer times and operating room preparation periods decrease. This allows teams to complete more cases with existing resources—vital as services tackle pandemic-related backlogs.
Theatre usage improves greatly. Teams can perform five consecutive ISBCS cases plus one unilateral case (eleven total surgeries) in a four-hour session, reaching 97.2% theatre utilisation. This beats nine consecutive unilateral cases at 90.4% utilisation.
Making the Right Choice for You
The choice between single or bilateral cataract surgery is unique to each person. Your personal situation plays a vital role in deciding the best surgical approach for your eyes.
Health conditions that affect your eligibility
Your general health greatly affects which surgical option is safest. Patients with diabetes, glaucoma, or macular degeneration might have less predictable healing. This makes surgeons careful about same-day bilateral surgery. These conditions often bring inflammation or structural issues inside the eye. Even dry eye syndrome can affect how smoothly you recover.
Your past reactions to medications matter too. Bad responses to eye drops, anaesthetics, or antibiotics suggest you might do better with one eye at a time. This lets doctors watch how you respond before they work on your second eye.
The NHS usually calls single-eye surgery the standard for patients with certain conditions. People with posterior subcapsular cataracts who have trouble with glare might get priority even when their visual acuity is better than 6/12.
How your lifestyle and priorities matter
Your daily activities and personal needs shape this decision. A detailed survey showed 92% of respondents said staying independent was their main concern about quality of life. The ability to drive ranked second.
Some patients like to take things slow. They want time to understand changes in their vision before a second procedure. Others want to get it done quickly. They prefer both eyes treated at once to spend less time away from work and family.
Thinking about cataract surgery? Speak with London’s leading ophthalmologists at Precision Vision London to find if single or double-eye surgery is right for you. Book your consultation today!
Surgeon recommendations and personalised care
Clear guidance from surgeons matters to most patients. Four out of five patients said their surgeon’s recommendation made them go ahead with surgery. Another study showed 61% of patients preferred their doctors to lead the decisions.
Top-quality care now has personalised risk assessments. Good clinics will only suggest bilateral same-day surgery after they really check your individual risk factors. Surgeons will delay your second eye surgery if they spot any issues during the first procedure.
The NHS now uses evidence-based tools to help make better decisions. These tools have detailed risk/benefit information and decision aids created with help from healthcare professionals and patients. These resources help you understand what matters most about possible outcomes. A specialist puts it best: “The most important thing is that you are comfortable with your decision. It is your choice”.
Comparison Table
| Aspect | Single (Staged) Surgery | Double (Bilateral) Surgery |
|---|---|---|
| NHS Standard Practise | Current standard approach | Less than 0.5% of NHS cases |
| Risk of Endophthalmitis | 0.056% | 0.045% |
| Visual Recovery | Temporary vision difference between eyes | Better binocular recovery; 92% achieve 20/40 vision within first week |
| Patient Satisfaction | Not specifically mentioned | 96.4% satisfaction rate; 89.7% would choose it again |
| Cost Efficiency | Higher costs from multiple visits | £402.64 less per patient |
| Operating Time | 48.71 minutes (two separate procedures) | 42.23 minutes (single bilateral case) |
| Hospital Visits | Several visits needed | Single admission and recovery period |
| Theatre Utilisation | 90.4% (nine unilateral cases) | 97.2% (five bilateral plus one unilateral case) |
| Biggest Advantage | Second eye adjustments based on first eye results | No vision imbalance between operations |
| Biggest Disadvantage | Anisometropia between surgeries | Both eyes heal at once; patient needs to sleep on back |
| Environmental Effect | Larger carbon footprint from multiple visits | Less waste and fewer hospital visits |
| COVID-19 Risk | More exposure from multiple visits | Lower transmission risk with fewer visits |
Conclusion
Choosing between single or bilateral cataract surgery is one of the most important healthcare decisions you’ll make. It depends on several personal factors. The NHS usually goes with staged procedures, but more evidence shows that same-day bilateral surgery works just as well for the right patients. The risk of serious complications like endophthalmitis stays about the same between both approaches when doctors follow strict protocols.
Patients who’ve had bilateral procedures tell us they don’t have to deal with annoying vision imbalances between surgeries. They also get back to normal vision faster. Same-day surgery saves money too. The environment benefits as well, with fewer hospital visits and less medical waste.
All the same, your health conditions, lifestyle needs, and priorities should guide what you choose. Some medical conditions like diabetes or glaucoma might make staged surgery a better fit. Your daily routine and how you feel about surgical procedures are vital factors in picking the best approach.
Thinking about cataract surgery? Speak with London’s leading ophthalmologists at Precision Vision London to discover if single or double-eye surgery is right for you. Book your consultation today!
Today’s cataract surgery shows how healthcare has shifted toward patient-focused care, better efficiency, and sustainability. While doctors once hesitated to do both eyes at once, bilateral cataract surgery has proven itself safe and effective. Many patients find it advantageous. Your eye doctor can look at your specific case, weigh the pros and cons, and help you pick the surgical approach that best fits your vision needs and lifestyle.
FAQs
Q1. Is bilateral cataract surgery recommended in the UK? Bilateral cataract surgery is not formally recommended as standard practise in the UK, but it is becoming more common, especially in private clinics. The decision to have both eyes treated simultaneously should be made on an individual basis after thorough consultation with an ophthalmologist.
Q2. What are the advantages of having both cataracts removed at the same time? Same-day bilateral cataract surgery offers several benefits, including faster visual recovery, elimination of interoperative vision imbalance, reduced hospital visits, and potential cost savings. Many patients report high satisfaction rates and improved quality of life following the procedure.
Q3. How safe is bilateral cataract surgery compared to single-eye surgery? Studies show that the risk of complications, including endophthalmitis, is comparable between bilateral and single-eye surgeries when strict protocols are followed. The theoretical risk of bilateral endophthalmitis is extremely low, estimated at less than 1 in 100 million cases.
Q4. How long is the recovery period after bilateral cataract surgery? Recovery after bilateral cataract surgery is generally quick. Most patients achieve driving-standard vision in at least one eye within the first week. By one week post-surgery, about 92% of patients achieve uncorrected distance visual acuity of 20/40 or better in both eyes.
Q5. Who is eligible for same-day bilateral cataract surgery? Eligibility for bilateral cataract surgery depends on various factors, including overall health, eye conditions, and lifestyle needs. Patients with certain medical conditions like diabetes or glaucoma may not be suitable candidates. A thorough evaluation by an ophthalmologist is necessary to determine if this approach is appropriate for you.
