Besides from a near-death experience riding the orange “Donkey Republic” rental bikes around the city center, the 43rd ESCRS (European Society of Cataract and Refractive Surgeons) Congress, held in Copenhagen, Denmark, this year was an absolute delight. I’m only (half) joking about the near-death experience, but what isn’t a joke was the amount of talks I attended that appeared devoted to the idea of immediate sequential bilateral cataract surgery (ISBCS) as a viable alternative to delayed sequential surgery.
The presenters covering this topic certainly put forth a convincing argument for the benefits involved in this type of procedure. Perhaps the most vocal of these – already a long-standing, known proponent of ISBCS in his native Canada – was Steve Arshinoff. Concluding a symposium titled “Future-Proofing Ophthalmology: Meeting Tomorrow’s Challenges” – which saw fellow illustrious presenters such as David Chang and Bruce Allan presenting on sustainability and technological integration, respectively – Arshinoff spoke on how eye surgeons might go about navigating reimbursement systems, regulators, and even governments, when performing ISBCS on patients.
It was an interesting speech, with Arshinoff stating that there has been zero litigation cases made against bilateral surgery (although he also told another guest speaker, the high-volume cataract surgeon Dr Neto Rosatelli, that he’d previously been arrested in Dr. Rosatelli’s home country of Brazil for performing ISBCS back when it was still illegal) and putting forth a case for the cost-effectiveness of operating on a bilateral cataract patient in one day, which he claimed could cut costs by around 30%.
One of Arshinoff’s main arguments was that general uptake of the procedure is limited, really, not by any infection or inflammation risks or any other harm to the patient, but by remuneration costs. Here, he pointed to both Canada and its distinct provincial legal systems, and their southern neighbors, where reimbursement laws for same-day cataract surgery vary state by state. “If anyone tells me that the difference is anything other than money, I don’t believe it,” Arshinoff concluded.
In somewhat more understated presentations, two separate groups of researchers presented their own respective findings on ISBCS.
The first group was a UK team based at Moorfields Eye Hospital, London, who evaluated the visual outcomes of monofocal versus multifocal intraocular lens implantation in immediate sequential versus delayed sequential bilateral cataract surgery. Their findings indicated that patients receiving same-day cataract surgery achieved visual outcomes comparable to those undergoing two separate procedures.
The second study was homegrown to ESCRS’s host country, conducted by a team of ophthalmic nurses and doctors at the Elective Surgery Centre in Silkeborg Regional Hospital, Denmark. This study was focused more on patient outcomes after ISBCS surgery, and their post-operative quality of life. Surveying a group of patients from the centre, the researchers found that a surprisingly high percentage (roughly two-thirds) of ISBCS patients can be sent home after surgery on the same day with no need for additional at-home care.
The Ophthalmologist has since spoken to both these groups of researchers, and more in-depth interviews elaborating on their findings will be published on the site in the not-too-distant future.
An interesting point to note: in both these interviews, both sets of researchers independently pointed to Steve Arshinoff’s own previous ISBCS studies (such as his 2003 Journal of Cataract & Refractive Surgery paper evaluating the outcomes and safety of the procedure) as inspiration for their own research.
As Arshinoff claimed in the Future-Proofing Ophthalmology symposium, the trend towards “ISBCS is increasing globally and will continue to accelerate.” And it is true that there does appear to be an increased global uptake of ISBCS, particularly in countries such as Spain, Finland and Sweden, where the procedure has been adopted as a routine option for patients.
But what do you think about ISBCS? And how might it apply to the country where you are based? I would love to hear your thoughts: Alun.Evans@Conexiant.com.
