EyeWorld India September 2016 Issue

September 2016 EWAP FEATURE 21 Views from Asia-Pacific Dandapani RAMAMURTHY, MD Chairman, The Eye Foundation Coimbatore, India Tel. no. +91-9443317791 drramamurthy@theeyefoundation.com I firmly believe ISBCS must be avoided and delayed sequential bilateral cataract surgery (DSBCS) must be the norm. Routinely, we do a complete work up for both eyes and operate on one eye. Patients have no perioperative restrictions on their diet, medications or activities. They return the next week, when after a complete evaluation of the first eye (no separate work up done), the fellow eye is operated upon and the patient encouraged to return to their routine. Except for two visits to the hospital, there is no disruption in the patient’s schedule. Evaluation of the first eye provides important information about power and type of IOL and for mono/micro-monovision, so that the two eyes complement each other functionally. Albeit rare, ISBCS carries the risk of bilateral endophthalmitis, TASS, CME, retinal detachment, glaucoma, corneal edema, etc. which could be devastating for patients and a legal and ethical nightmare for the physician, especially considering that many of our patients today are in the prime of their productive lives with early cataracts. Since ISBCS ideally requires reprepping, redraping, rescrubbing, and replacement of all instruments and fluids, between the two eyes, it is more time- consuming than DSBCS. In some instances, reimbursement is also significantly lower for ISCBS than for DSBCS. Overall, I believe DSBCS is safer, not significantly more time consuming and gives an opportunity to learn from the first eye and fine tune the outcomes in the fellow eye. Editors’ note: Dr. D. Ramamurthy is a consultant for Abbott Medical Optics (Abbott Park, Illinois) and Alcon (Fort Worth, Texas). Hiroko BISSEN-MIYAJIMA, MD, PhD Professor, Tokyo Dental College Suidobashi Hospital 2-9-18 Misaki-cho, Chiyoda-ku, Tokyo, Japan 101-0061 Tel./Fax no. +81-3-5275-1912 bissen@tdc.ac.jp T here is no doubt that ISBCS has advantages in the patient’s valuable time and the clinic’s cost performance. I think most ophthalmologists agree that intra- and postoperative complications in modern cataract surgery are rare, and performing surgery on both eyes on the same day would not increase these risks. I admire the strong recommendation and continuous presentations at international meetings by Dr. Steve Arshinoff. He is convinced that the vision threatening complication of endophthalmitis would not be the issue for ISBCS. He has also researched the situation in different countries. According to the members’ survey of the Japanese Society of Cataract and Refractive Surgery (JSCRS), only 2.7% of the members are performing ISBCS, and most of them are based in private clinics. The percentage of ISBCS in Japan is lower than that of ASCRS and ESCRS. I think there are various reasons. The unique part of Japanese health insurance is that the cost of hospitalization would be covered. During his or her stay at the hospital, both eyes are operated under the interval of 2 to 7 days. Why don’t we do ISBCS even if we know that ISBCS is safe and efficient? As Drs. Stiverson and Mamalis pointed out, we can adjust the visual outcome of the second eye based on the result of the first eye. This is very important when we implant premium IOLs such as toric and multifocal IOLs. In case of toric IOLs, we can modify unexpected under- or overcorrection of corneal astigmatism in the second eye. In case of multifocal IOLs, we will have a chance to change the model after the patient’s visual experience with the new IOL. For example, one may change the near additional power of multifocal IOL after confirming the reading distance of the first eye. I agree that cataract surgery in both eyes on the same day is beneficial for the patient. However, the chance of enhancing the visual outcome by additional days would have more benefit in certain cases. I think we should be flexible in choosing ISBCS or DSBCS depending on the situation. In general, the acceptance of ISBCS is increasing and more surgeons would consider ISBCS if it would bring the benefit over DSBCS. Editors’ note: Dr. Bissen-Miyajima is a consultant for Abbott Medical Optics (Abbott Park, Illinois), HOYA (Tokyo, Japan), and Santen (Osaka, Japan). continued on page 22