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Cataract Surgery in the Second Eye

American Association of Opthamology

This article was written for physicians. Patients should talk to their Eye M.D. if they have questions about the content.


Indications for Surgery
The primary indication for surgery is when vision impaired by cataract no longer meets the patient's needs and surgery provides a reasonable likelihood of improved visual function. Cataract removal is also indicated when there is evidence of lens-induced disease (e.g., phakomorphic glaucoma, phakolytic glaucoma, etc.) or when it is necessary to visualize the fundus in an eye that has the potential for sight (the latter includes a diabetic patient who is at risk of visual loss from retinopathy or other special investigations that demonstrate intraocular pathology, both of which require clear media for optimal management).


Benefits of Second-Eye Surgery
Cataract surgery in both eyes is an appropriate treatment for patients with bilateral cataract-induced visual impairment in order to restore binocular vision. Three studies comparing the outcomes of first- and second-eye surgeries after extracapsular cataract extraction concluded that patients who underwent surgery in both eyes had greater improvement in functional status than did those who underwent surgery in one eye,1-3 and another study demonstrated improved binocular function and ability to meet a driving standard.4 Patients who had surgery in both eyes also have been shown to have statistically significant improvement in satisfaction with vision than patients who had surgery in only one eye.2 Another study demonstrated that the cataractous eye interfered with the function of the pseudophakic eye, and after surgery on the second eye, multiple complaints of visual disability were eliminated.5


Timing
Consideration of the appropriate interval between the first-eye surgery and second-eye surgery is influenced by several factors: the patient's visual needs, the patient's preferences, visual acuity or function in the second eye, the medical and refractive stability of the first eye, the need to develop binocular vision and the presence of symptomatic anisometropia as well as logistical concerns of the patient in traveling back and forth to the physician's office. The patient and ophthalmologist should discuss the benefit, risk and timing of second-eye surgery when they have had the opportunity to evaluate the results of surgery on the first eye.


Conclusion
Patients receiving second-eye surgery experience significant improvement in visual function. The indication for second-eye surgery is the same as for the first eye. Prior to performing surgery on the second eye, the patient's first eye should have a stable postoperative refraction and the patient should perceive improved function, and sufficient time should have elapsed to evaluate and treat early postoperative complications, such as endophthalmitis. In addition, the patient needs sufficient time to assess the results of his or her first-eye surgery to determine the need and appropriate timing for surgery in the second eye.


References

  1. Javitt JC, Brenner MH, Curbow B, et al: Outcomes of cataract surgery-improvement in visual acuity and subjective visual function after surgery in the first, second, and both eyes. Arch Ophthalmol 1993; 111:686-91.
  2. Javitt JC, Steinberg EP, Sharkey P, et al: Cataract surgery in one eye or both: a billion dollar per year issue. Ophthalmology 1995; 102:1583-93.
  3. Cassells X, Alonso J, Ribo C, et al: Comparison of the results of first and second cataract eye surgery. Ophthalmology 1999; 106:676-82.
  4. Talbot EM, Perkins A: The benefit of second eye cataract surgery. Eye 1998; 983-9.
  5. Laidlaw A, Harrad R: Can second eye cataract extraction be justified? Eye 1993; 7:680-6.

© Copyright 2000 American Academy of Ophthalmology

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