Cataract surgery: a quick look

If you need cataract surgery for both eyes, is it better to have them done on the same day or on different days? Sarah Chapman looks at the evidence and what else you might want to think about.

There is a longer version of this blog – “Cataract surgery: both eyes on the same day or on different days?” which has more discussion and detail. Both blogs have links to useful information for patients. 

Take-home points

Take-home points: Cataracts, where the lens of the eye goes cloudy, are common. They can be taken out in a short operation and a clear plastic lens put into the eye instead. Some people who need two cataracts done may be able to choose whether to have both done on the same day or on different days. There is evidence that there are probably no important differences in results whether two eyes are done together or not. If you are making this choice, you might want to think about practical differences between the two. For example, two eyes done together means fewer hospital appointments and only having to recover once.

The evidence comes from the Cochrane Review Surgery on both eyes on the same day or on different days: which works better to treat cataract in both eyes? (April 2022). It is about people with cataracts in both eyes due to ageing.

Cataracts, or cloudy lenses of the eye, are common as we get older. They get worse over time and can make ordinary things, like driving, difficult.

A cataract can be taken out and replaced with a clear plastic lens in a short operation, usually under local anaesthetic, where you’re awake but it won’t hurt. If you have them in both eyes, and your doctor thinks you are at low risk of problems, you may be able to choose whether to have both done together.

A cataract doesn’t have to get ‘ripe’ before it can be taken out.

Making a choice? Think BRAIN!

It can be helpful to think BRAIN: What are the Benefits, Risks, Alternatives, what do want and what if I do Nothing? These can be good questions to talk about with your eye doctor.

What are the benefits of having two eyes done at once?

The evidence says there is probably no difference in how good your vision will be when you have got over the operation(s), whether you have them done together or on different days. But with two eyes done together, you will see better sooner than if you have some weeks with one ‘good’ eye and one with a cataract.

People who have the first eye done are more likely than usual to fall over, in the weeks waiting for the second eye to be done. Having both eyes done at the same time means not having this higher risk of falling.

Practical benefits:

  • Fewer hospital appointments
  • One operation day
  • Only one operation to recover from instead of two (and so less time when you will need help at home and less disruption to your usual activities)
  • The costs and/or difficulty of getting extra help at home, for example, or lifts/taxis to go to appointments, will be less for one operation compared with two.

A few people, such as those with learning difficulties, need to have this surgery under general anaesthetic. There is always a tiny possibility that something will go wrong when you have a general anaesthetic. Having both eyes done at the same time means risking this just once.

What are the risks?

There is a risk of the eyes getting infected but this is rare. The evidence says it may make no difference to infection risk whether both eyes are done together or on different days, though it happens so rarely that we can’t be sure.

There are things the doctors and nurses will do to make infection even less likely to happen, such as using antibiotics during the operation and treating each eye as if they belong to two different people – using fresh equipment for each, for example.

What are the alternatives?

Apart from maybe having the choice between having both eyes done together or on different days, you could check with your eye doctor whether there are other things you could try. For example, might new glasses help you?

What do I want?

What matters to you is really important when making choices about any treatment. You may feel that there are practical things that make one option best for you, depending on your circumstances. Are you a carer? Is it easy or difficult to get to appointments, or to have help at home after the operation? Is it important that you get back to driving quickly? Would you prefer to get it all over in one go? These are the kinds of things you might think about.

What if I do nothing?

This is a question you can ask your eye doctor, who can tell you what you can expect if you leave your cataracts alone and whether you might need to stop driving, for example. It might be that you don’t want surgery just now, but may want to think about it again later on.

Find out more

The Cochrane Review:

Dickman MM, Spekreijse LS, Winkens B, Schouten JSAG, Simons RWP, Dirksen CD, Nuijts RMMA. Immediate sequential bilateral surgery versus delayed sequential bilateral surgery for cataracts. Cochrane Database of Systematic Reviews2022, Issue 4. Art. No.: CD013270. DOI: 10.1002/14651858.CD013270.pub2

Join in the conversation on Twitter with @CochraneUK @SarahChapman30 or leave a comment on the blog. 

Please note, we cannot give specific medical advice and do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion but we ask that comments are respectful and reserve the right to not publish any we consider offensive. Cochrane UK does not fact-check – or endorse – readers’ comments, including any treatments mentioned.

Sarah Chapman has nothing to disclose.



Cataract surgery: a quick look by Sarah Chapman

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

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