I enjoyed reading the article by Buchan et al. [1], and agreed with the authors’ proposals until I read that ‘Bilateral cataract patients can be treated with just three hospital visits…’ but surely the answer should be 2 not 3? If the patient has bilateral cataract and no specific contraindication, why can they not have a first hospital visit to confirm the diagnosis, obtain consent and biometry, followed by second hospital visit for ISBCS (Immediate Sequential Bilateral Cataract Surgery)? Follow-up and data on optical outcomes can be done in the community by accredited optometrists.
The risk of bilateral endophthalmitis, which has never been described with modern techniques correctly applied, is now calculated to be of the order of 1 in 12 million operations [2]. TASS should never occur and is probably rarer than endophthalmitis although hard data doesn’t exist. Fears about biometry have largely been overcome with optical biometry and improved formulae such as the Hill RBF. Published data from a large American series shows no difference in outcome between ISBCS and 2 delayed sequential cataract surgery [3].
In seeking improvements, we should not cling to outdated fears which complicate cataract management pathways. The UK should follow other countries such as Finland where the cost advantage of 839€ per patient (at 2011 costs) is well recognised [4] and conversations with local ophthalmologists indicate that the majority of cataract surgery is now ISBCS.
There is nothing more powerful than an idea whose time has come.
Compliance with ethical standards
Conflict of interest
The author declares that he has no competing interests.
References
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