NEWS & OPINION 52 EWAP JUNE 2023 (68/94) of eyes achieved a UDVA of 20/40 or better by POD1 and 92% (214/232) by POW1. Nearly all patients (115/116) achieved 20/40 or better acuity in at least one eye by POW1. For those eyes that performed 20/50 or worse by POW1 (18 eyes), five (28%) had known baseline conditions that limited postoperative visual potential. Discussion Among patients and providers alike, ISBCS has become an area of worldwide interest as well as a source of debate. Although Kwedar et al. do not comment on the advantages and disadvantages of the surgery itself, they present data that help guide immediate postoperative expectations, which are central to patients considering the procedure. A key takeaway is that compared to preoperative CDVAs, 83% of patients targeted for emmetropia will achieve the same or better UDVA in at least one eye by the first day following ISBCS (90% by week 1), with a median acuity of 20/30 per eye. By postoperative week 1, the acuities of nearly all patients met or exceeded the minimum driving require ments in Missouri and similarly for a majority of states (i.e., 20/40 or better distance vision in at least one eye). 8 Limitations of the study included a lack of tabulated patient characteristics and a robust surgical exclusion criteria, which prevented subgroup analysis on any one demographic or of patients with certain ocular comorbidities (e.g., diabetic macular edema). These limitations decreased the study’s generalizability, including for patients whose baseline conditions may predispose them to visually significant complications in the early postoperative period (e.g., Fuchs dystrophy). While previous studies have demonstrated that ultimate refractive outcomes of ISBCS are comparable to DSBCS, 7,9,10 Kwedar et al. provide objective data on the short-term refractive timeline following the former. The data suggest that many patients who undergo ISBCS may expect swift postoperative visual improvement of at least one eye, minimally impacting activities such as driving. Although further studies are indicated for specific populations, the results provide a general basis for conversation when addressing patient concerns regarding the course of visual recovery following ISBCS. EWAP References 1. Chan JO, De La Paz P. Bilateral cataract extraction in one sitting. J Philipp Med Assoc. 1952;28:700–705. 2. Kessel L, et al. Immediate sequential bilateral cataract surgery: a systematic review and meta-analysis. J Ophthalmol. 2015;2015:912481. 3. Grzybowski A, et al. Pros and cons of immediately sequential bilateral cataract surgery (ISBCS). Saudi J Ophthalmol. 2016;30:244–249. 4. Naderi K, et al. Attitudes to cataract surgery during the COVID-19 pandemic: a patient survey. Eye (Lond). 2020;34:2161–2162. 5. Shah V, et al. Acceptability of immediate sequential bilateral cataract surgery (ISBCS) in a public health care setting before and after COVID-19: a prospective patient questionnaire survey. BMJ Open Ophthalmol. 2020;5:e000554. 6. Malcolm J, et al. Immediate sequential bilateral cataract surgery: patient perceptions and preferences. Eye (Lond). 2022. Online ahead of print. 7. Sarikkola AU, et al. Simultaneous bilateral cataract surgery: a retrospective survey. J Cataract Refract Surg. 2004;30:1335–1341. 8. Driving Restrictions per State. EyeWiki. eyewiki.aao.org/ Driving_ Restrictions_per_State. Accessed February 20, 2023. 9. Sarikkola AU, et al. Simultaneous bilateral versus sequential bilateral cataract surgery: Helsinki Simultaneous Bilateral Cataract Surgery Study Report 1. J Cataract Refract Surg. 2011;37:992–1002. 10. Serrano-Aguilar P, et al. Immediately sequential versus delayed sequential bilateral cataract surgery: safety and effectiveness. J Cataract Refract Surg. 2012;38:1734–1742. Visual recovery after immediate sequential bilateral cataract surgery at a veterans’ hospital Kwedar K, et al. J Cataract Refract Surg. 2022;48:1260–1263. Purpose: To answer patient questions about the expected timeline for recovery, the objective postoperative visual acuities were reviewed for patients undergoing immediately sequential bilateral cataract surgery (ISBCS). Setting: Harry S. Truman Memorial Veterans’ Hospital in Columbia, Missouri. Design: Retrospective chart review. Methods: All patients who underwent ISBCS in 2019 were evaluated. A total of 116 patients (232 eyes) were studied. Uncorrected distance visual acuity (UDVA) for postop day 0 or postop day 1 (POD0/1), postop week 1 (POW1), and postop month 1 (POM1) were required for study inclusion. Patients with ocular comorbidities were not excluded, though all patients passed an initial screen in order to qualify for ISBCS. Outcome measures included POD0/1, POW1, and POM1 UDVA. Results: Postoperative UDVA was stable or improved compared to preoperative corrected VA (CDVA) for 48% (66/138) of eyes on POD0, 79% (74/94) of eyes on POD1, and 90% (209/232) of eyes on POW1. 83% of patients at POD1 and 90% of patients at POW1 had stable or improved VA in at least one eye. 92% (214/232) of eyes had a POW1 UDVA of 20/40 or better. Of the 18 eyes with a postoperative POW1 UDVA of 20/50 or worse, 5 (28%) were known preoperatively to have limited visual potential. 99% (115/116) of patients had at least one eye 20/40 or better. Conclusion: Most patients who underwent ISBCS demonstrated meaningful improvement in UDVA compared to preoperative CDVA as early as POD1. These results serve to guide discussion of postoperative expectations with patients interested in ISBCS.
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