Shedding the Cloak of Customary Practice?

SURVEY OF OPHTHALMOLOGY

VOLUME 57  NUMBER 6  NOVEMBER–DECEMBER 2012

VIEWPOINTS L. JAY KATZ, HERMAN D. SCHUBERT, AND THOMAS SLAMOVITS, EDITORS

INTRODUCTION Shedding the Cloak of Customary Practice? When there is a consistent approach that is timehonored then a sense of comfort with familiarity embeds a routine that may become difficult to dislodge. Cataract surgery enjoys a well deserved reputation for being an extraordinarily successful procedure. With the exception of children who require general anesthesia, unilateral surgery has been the standard of care for intraocular surgery. Dr. Arshinoff challenges this approach with an ‘‘out of the box’’ series of thoughtful arguments in favor of simultaneous bilateral cataract operations.1 He cites the rapid recovery, cost savings, and the relative safety of modern operative techniques. Drs. Henderson and Schneider2 counter with the concerns expressed about postoperative complications like endophthalmitis or secondary glaucoma. Catastrophic postoperative problems are fortunately a very rarely encountered phenomenon, however. Does that mandate a strict dictum of only offering surgery for only one eye at a time? Stepping back and reassessing our roles as physicians and patient advocates we need to be open to novel ideas that threaten traditional concepts of care. There may be an inclination on the part of certain patients who wish to accept the small risk of bilateral complications in order to have both eyes rehabilitated simultaneously with fewer trips for ocular care. In orthopedics, bilateral knee replacement surgery has been readily adopted by many as a sensible approach for select patients. With phacoemulsification, small-incision surgery, foldable

lenses, short operative time, and viscoelastic use (to name a few of the modifications of current cataract surgery), the operation has been radically changed for the better over the past 20 years. Is our standard approach of cataract surgery one eye at a time an outdated concept based on our experiences with cataract surgery techniques from a quarter century ago? Perhaps a careful re-evaluation of our staunch opposition to bilateral cataract surgery is in order. As a start, a discussion with patients of the pros and cons of such an approach with our own admittedly biased views will allow some patients, after this informed decision-making, to voice their choice for traditional or bilateral surgery. If as a surgeon one feels comfortable with some patients’ choice of bilateral surgery, then personal experience with this novel concept will dictate whether it will be embraced or discarded. L. Jay Katz, MD Viewpoints Editor

References 1. Arshinoff S. Same-day cataract surgery should be the standard of care for patients with bilateral visually significant cataract. Surv Ophthalmol. 2012;57(6):574--8 2. Henderson BA, Schneider J. Counterpoint: Same-day cataract surgery should NOT be the standard of care for patients with bilateral visually significant cataract. Surv Ophthalmol. 2012; 57(6):580--3

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