Usually one of the eyes will have a worse cataract than the other. Most doctors will decide to operate on just one eye and not perform simultaneous surgery in both eyes to balance vision. Most doctors suggest an advisable gap between two cataract surgeries and there’s quite a good reason behind it.

All that being said, many patients also like having surgeries on both eyes, known as same-day bilateral cataract surgery, on the same day due to their anxiety or personal preferences. While it may work in some cases, some cases demand a good gap between two surgeries for your eye health and comfort. Vision Concern is here to help you understand whether you should prefer a gap or have the surgery done on both eyes together.

What is the minimum time I need to wait between two cataract surgeries?

Your doctor knows full well how long you should wait before having two cataract surgeries. Normally, a gap of approximately a month before having your cataracts removed from the other eye is good, says the National Eye Institute. 

Why this long you may ask. Well, the gap ensures that you always have a good level of vision. Moreover, it also lets your doctor observe your eye as it recovers from the procedure. Some people can also wait years before the second surgery. 

How long you wait will depend on how much your cataracts are currently affecting your vision. Here’s a detailed overview of the recommended timeframes:

• 3 to 4 Weeks: Usually it is suggested to space out the surgical procedures between 3-4 weeks. It will be comfortable for the first eye recovery and will take care of complications, besides enabling the surgeon to assess the visual outcome of the first eye before proceeding with the second.
• 1 to 2 Weeks: Some doctors recommend a shorter interval of 1 to 2 weeks. This way, they tend to speed up the visual rehabilitation and shorten the duration of visual imbalance from the two eyes.
• 48 Hours to 7 Days: In fact, sometimes just as short as 48 hours or up to 7 days may be considered acceptable periods when stable and uncomplicated from the first surgery.

Factors influencing the gap

The gap in cataract surgery, referring to the delay or decision not to undergo the procedure, is influenced by a variety of factors including:

1. Health and medical factors

• Old Age and Other Comorbid Conditions: Advancing years is a strong risk factor for the increase in postoperative complications. That may prompt patients away from operation if visual acuity exceeds their standards.

Patients with diabetes mellitus, hypertension, and kidney failure could frequently get unsatisfactory results from surgery. Thus more caution in performing their surgeries is needed.

• Eye Comorbidities: In case of age-related macular degeneration, and other ocular diseases like glaucoma and corneal pathologies, it is hard to perform cataract surgery on a patient. Patients with these diseases are usually not considered for surgery due to guarded visual prognosis because of significant ocular co-morbidity.

2. Operational Factors 

• Type of Surgery: The type and severity of the surgical procedure for cataracts a patient undergoes also define the outcome. For example, patients undergoing extracapsular cataract extraction and intracapsular cataract extraction are more prone to feeling dissatisfaction with their self-visual results compared to those who have undergone phacoemulsification.
• Intraoperative Complication: The rupture of the posterior capsular rupture is the most challenging complication which significantly increases the risk for poor visual acuity postoperatively Extensive study has been done to correlate intraoperative complications with poorer visual outcomes.

3. Social and economic factors

• Willingness to Pay: Economic factors impact access to cataract surgical intervention. Patient willingness to pay for surgery depends on individual factors such as age, health status, and household income. In rural areas, lower economic status determines whether a patient will go for surgical care.
• Patient Education and Emotional Condition: The education of patients regarding the benefits and risks of cataract surgery also influences decisions on undergoing the procedure. The emotional readiness for surgery and understanding of post-operative improvements in quality of life would be vital here.

4. Timing between surgeries

• Surgeries interval: The interval for patients with bilateral cataract surgeries is determined by their visual demands, refractive stability of the first eye, and post-first surgery overall patient condition. Such patients are usually recommended to have an interval ranging from one to seven days between the two eye surgeries.

Possible complications of cataract surgery

First thing first. The chance of getting complications post-cataract surgery is low. However, any surgical procedure possesses some risks. These possible complications from cataract surgery are  also a reason why doctors suggest the gap:

• Double vision
• Blurred vision
• Vision loss
• Retinal detachment
• A rare infection named endophthalmitis
• Allergy reactions to anesthesia
• Secondary cataracts

What are the benefits of having cataract surgery in both eyes?

Cataract surgery often allows you to have a good view which may reduce the chances of falling, observing more clearly who are your friends or relatives, as well as other possible things.

• Better Visual Acuity: Research shows that patients who have surgery on both eyes experience a 61% improvement in visual function over those who undergo such surgery on one eye only. 

Further, about 90% report an improvement in their visual acuity after surgery, with more than 95% satisfaction amongst those without other eye conditions.

• Improved Life Quality: Patients who reported developing their daily activities, such as reading, driving, and identifying faces, identified seeing more clearly in bright colours and glare-free sight, which improved the quality of their visual experiences.
• Excellent Depth Perception: Better to have both eyes treated at once since it doesn't make much difference in depth perception but helps and is critical while driving in an enclosed space.
• Low Fall Experience: Improvement in vision decreases the risk of falling and increases mobility which contributes to independence.

Surgical Considerations

• Surgery Timing: Immediate sequential bilateral cataract surgery (ISBCS) is not for everyone. It is usually appropriate for low-risk patients, while most will have surgeries spaced 1 week to 4 weeks apart for recovery and assessment of the first eye's healing.
• Recovery: In general, a patient needs 2 to 6 weeks to recover from cataract surgery, during which time their vision stabilizes. Patients will then be seen in follow-up to monitor their condition after surgery.

Why not have cataract (motibindu) surgery in both eyes at once?

You will have to keep your eye covered in the first hours after undergoing a cataract operation. After the surgery is done for about two to three weeks you will see the result of that surgery and eventually have clear vision out of one eye.

What might happen is a little uncommon and a great risk associated with cataract surgery in both eyes: the threat of infection in both eyes. An infection occurring during routine cataract surgery is called endophthalmitis, but during bilateral cataract surgery, there is a risk of transferring the infection to the other eye.

Endophthalmitis can complicate the situation resulting in severe conditions, but surgery must be performed on each eye at different times to prevent it.

Do you always need cataract surgery in both eyes?

No. Cataracts frequently progress slowly or unevenly. They may be detected by your eye doctor early in their formation or perhaps not at all until the vision is affected by cloudiness, which starts wreaking havoc on day-to-day life.

You could go for cataract surgery in one eye as many as five or more years before that eye's vision becomes problematic enough to warrant surgery. Many people find such improvement after one cataract surgery that they feel no need for surgery in the other eye.

Cataract surgery gone wrong? How long to wait before getting reoperation?

YAG laser capsulotomy is the treatment for these "secondary cataracts." The symptoms are similar to those of original cataracts. Usually, this outpatient procedure is simple and quick. It restores vision by creating an opening with a special laser for the capsule. This restorative procedure is painless, lasts just a few minutes, and is usually not repeated. Here are the points regarding reoperation after failed cataract surgery:

Timing for Reoperation

• Initial Recovery Period: The majority of complications necessitating reoperation occur during the first 30 days post-surgery. Studies reveal that over 70% of these reoperations occur in this window.
• Extended Recovery: Additional cases would necessitate reoperation from 31 to 90 days postoperatively depending on the complications such as retained nuclear fragments or dislocated intraocular lenses (IOLs).
• Surgeon's Evaluation: The timing of a second operation depends on how the patient is healing and on the specific problems that arose in the first surgery. Generally speaking, surgeons examine the eye condition before suggesting subsequent procedures.

Common Reasons for Reoperation

• Retained Nuclear Fragments: It may prompt further surgery if residual cataract material is found within the eye.
• Dislocated IOLs: An artificial lens might need to be repositioned or replaced if it is malpositioned.
• Incision Leaks or Complications: It would require repair if there are some postoperative complications relating to the incision.

How are unilateral cataract surgery and bilateral cataract surgery different?

Conclusion 

The time frame between cataract surgeries for each eye is generally determined by the following factors: health status of the patient, severity of cataracts, and recommendations by the surgeon. Generally, it is recommended that cataracts be done within 1 to 4 weeks, but specific timing depends on individual medical advice and the patient's needs. For individualized guidance on the timing of cataract surgery, contact our experts at Vision Concern.

FAQs

1. How long does cataract surgery take?

Ans: The actual procedure may take about 15-30 minutes but they should count up to arrival and discharge so about 2-3 hours in the hospital for the patients.

2. What are some reasons for postponing the surgery of the second eye?

Ans: The surgery is delayed due to complications arising from the first surgery, the time needed for healing the first eye, or the need to assess visual outcomes before considering the surgery for the second eye.