Perception Of Canadian Ophthalmologists On Immediately Sequential Bilateral Cataract Surgery (Isbcs) – Insights Gained And Implications

Immediately sequential bilateral cataract surgery (ISBCS) remains a topic of great controversy in ophthalmology. Despite well-known advantages including faster visual rehabilitation and cost-effectiveness, there remain many barriers to the widespread acceptance of ISBCS. As a result of the COVID-19 pandemic, there has been renewed interest in ISBCS as a viable solution to surgical backlog and reduce patient visits. Our study aimed to survey Canadian ophthalmologists on their perception regarding ISBCS to gain insight on their current practice patterns, their concerns with ISBCS, and changing perspectives in the context of the pandemic.

An anonymous survey hosted on REDCap was sent to all active members of the Canadian Ophthalmological Society.

This is a cross-sectional, survey-based study on the practice of ISBCS among ophthalmologists across Canada. Basic demographic information was collected, including gender, age, years of practice, province of practice, main work setting (i.e., private office/clinic, academic center/teaching hospital, or community hospital). Respondents were asked questions regarding their current practice as cataract surgeons, including whether they practiced ISBCS routinely, in exceptional cases only, or do not perform itat all. Perceived advantages, disadvantages, and concerns regarding ISBCS were compared between ophthalmologists who perform ISBCS and those who do not. 

A total of 352 ophthalmologists responded. Among these, 94 respondents (27%) practice ISBCS routinely, 123 (35%) in exceptional cases and 131 (37%) do not practice ISBCS. ISBCS practitioners were significantly younger than non-practitioner, had a shorter duration of practice and mainly worked in academic centers (p< 0.001). The prevalence of ISBCS practitioners varied significantly by province (p<0.001). The main reason for performing ISBCS was cost-effectiveness (n=142, 65%) and the main concerns were the risk of bilateral complications (n=193, 57%). The COVID-19 pandemic positively influenced the view of 152 respondents (43%), but this was mostly among practitioners that already perform ISBCS routinely (n=77, 84%).

ISBCS practitioners are more likely younger ophthalmologists working in academic centers. Most routine ISBCS practitioners were from Quebec, where financial disincentives are lowest in the country. ISBCS practitioners were positively influenced by the COVID-19 pandemic to offer ISBCS more often,
compared to non-ISBCS practitioners.