Patient Experience Of Immediate Sequential Bilateral Cataract Surgery (Isbcs) – A Single Centre Review

This study aims to assess the outcomes and patient experience of Immediate sequential bilateral cataract surgery (ISBCS). ISBCS is becoming more common in practice following the COVID-19 pandemic and many Eye Units now offer suitable patients the choice of same day bilateral surgery. This study aims to look at the prevalence of these surgeries, surgical outcomes, patient demographic and most importantly; patient experience. Factors such as overall patient satisfaction, travel, time to return to activities of daily living (ADLs) as well as carbon emissions will be looked at in this study. It will also look into the reasons patient choose ISBCS instead of the existing standard alternative

The 2017 UK NICE guidance suggests that ISBCS should be considered for: those who are at low risk of ocular complications; or those who need general anaesthetic but for whom general anaesthesia carries an increased risk of complications and/or distress. The RCOphth guidelines on ISBCS further add that case selection should include visually significant bilateral cataracts with no absolute contra-indications (e.g. ocular co-morbidities, pre-existing eye injury and previous refractive surgery).

A retrospective analysis of all ISBCS cases from January 2024 - March 2024 at the Eye Unit in East Surrey Hospital was undertaken. Data was collected using theatre lists and Medisight operative notes coded for ISBCS. Outcomes such as visual acuity, post-operative complications and refractive outcome were recorded from Medisight. Patients were then telephoned by an ophthalmologist to complete a short survey where further information was gathered. This included obtaining an overall patient satisfaction with a score of 1-5 (5: very satisfied), indications for choosing ISBCS, activities of daily living post-operatively, transport details and post-operative support.  Carbon emissions were calculated using an online calculator.

46 patients (28 female) were included in the survey. The majority of patients were over 60 years old (n=40), 40-60 year olds (n=5) and one patient under the age of 30. 9% of patients underwent general anaesthetic. Post operative complications included macular oedema (5 eyes) and corneal oedema (2 eyes). 79% of patients reported that they were very satisfied with the outcome and experience of their surgery. 30% of patients chose to have ISBCS for the convenience of having both eyes done on the same day, 19% due to anxiety, 24% due to logistics and 14% due to concerns of post-operative anisometropia. 33% of patients returned to their ADLs the same day with 64% within 48 hours. 45% of patients who underwent ISBCS lived alone.

This study highlights the importance of patient choice and satisfaction with ISBCS. The majority of patients choose to do so for convenience; reducing hospital visits and post operative recovery to one single event. We also looked at the effect of carbon emissions - studies have indicated that patient transport accounts for about 7% of total ghg emissions in cataract surgery so this small reduction can still have an impact on the total emission amount. Interestingly, nearly half of the patients in the study lived alone, yet still opted for ISBCS. Outcomes for time to ADLs show that loss of independence post operatively should not necessarily be a deterrent as over half the total patients returned to normal activities the within a day.