Operating on both eyes on the same day

Covid-19 has led to a number of changes in the way we operate. One change that is here to stay is operating on both eyes on the same day. We have been moving in this direction for some time, and the push to streamline care emerging from the Covid-19 crisis has probably been the stimulus we all needed to make the change. Professional bodies in the UK and internationally including the Royal College of Ophthalmologists and the European Society of Cataract and Refractive Surgery (ESCRS) are now actively encouraging same day surgery in both eyes.

We are currently asking you to self-isolate and test before surgery. The advantages of doing this just once are clear. But are there any disadvantages for operating in both eyes on the same day?

Most of the arguments that used to apply have fallen by the wayside.

We used to think that you could improve the accuracy of the focus result in your second eye using information from the outcome in the first. Modern lens prediction formulas are now so accurate that any advantage here is likely to be very small, and laser focus adjustments are normally very effective when needed.

Surgery in each eye is treated completely separately, and systems are in place to minimise any risks additional risks associated with operating on both eyes in the same session. These include separate manufacturing batches for the fluids we use in surgery, separate sterilization cycles for the instruments we use, and systems to protect from left/right eye confusion in lens implant choice. The aim is to ensure that the risks of surgery are the same whether you have both eyes operated on 5 minutes, 5 days or 5 months apart.

You can see well enough to walk around within an hour of surgery, and vision improves quickly in the next few days. We no longer use eye patches. Any discomfort after surgery should be minor, and you can wash and shower normally from day one after treatment.

Beyond convenience, same day surgery also helps your vision to recover smoothly. The eyes are designed to work as a pair, and having both working together from the get-go helps the visual areas of your brain to adapt quickly to the new visual input. This is particularly important for multifocal intraocular lenses, in that it avoids the awkward week of lopsided visual input that you would otherwise experience.

So, the consensus has shifted, and we will be offering same day surgery in both eyes as our default going forwards from here. But it will always be your choice. If you are more comfortable having one eye done then having a break and coming in for the other eye on another day, no problem. Just let us know.

Bruce Allan

July 2020

E: moorfields.ballan@nhs.net T: 02075662156