Sequential bilateral cataract surgeries: Safe viable protocol to decrease elective surgery volume


Investigators found that implementing immediately sequential bilateral cataract surgery reduced the number of patient visits by 50%.

Patients check in at a doctor's office waiting room. Image credit: ©jovannig –

Researchers called ISBCS "a safe and effective option to supplement surgical volume." Image credit: ©jovannig –

Simrenjeet Sandhu, MD, and colleagues from the Department of Ophthalmology, University of Alberta, Edmonton, reported that immediately sequential bilateral cataract surgery (ISBCS), which was implemented during the COVID-19 pandemic, appears to be safe and effective during periods when reductions in surgical volume are desired.

The investigators evaluated 406 patients who underwent ISBCS from July to December 2020 in a so-called quality-improvement study.

The surgeons explained that they used the Model for Improvement2 framework to guide their study, which involved plan-do-study-act cycles, allowing for continuous innovation, evaluation and improvement.

They explained that the aim of this study was to review and adapt the ISBCS best practices, address stakeholder concerns, and obtain frontline perspectives to better use operating room time during the COVID-19 pandemic. The goal was that each surgeon would complete 5 ISBCS cases daily on each surgical day, increasing the daily cataract volume/surgeon in 6 months. The goal of 5 cases daily was based on the number of surgeons, past procedure time history, the allocated operating room time and the number of patients on the waitlist.

The investigators collected adverse outcomes and overall impact from various levels of staff involved in the project. Each eye was treated as a separate surgery with a double time-out per bilateral case.

The investigators found that implementing ISBCS increased the surgical volume by approximately 25% and reduced the number of patient visits by 50%, reducing potential COVID-19 exposure. No eyes developed toxic anterior segment syndrome (TASS) or endophthalmitis.

Sandhu and colleagues concluded, “The resulting protocol from our study may be useful for other centres wishing to integrate ISBCS as one example of successful implementation. Of the 406 cases of ISBCS performed, we report zero cases of TASS or endophthalmitis. In times of decreased elective surgeries, ISBCS is a safe and effective option to supplement surgical volume and provide significant patient benefits.”


  1. Sandhu S, Liu D, Mathura P, et al. Immediately sequential bilateral cataract surgery (ISBCS) adapted protocol during COVID-19. Can J Ophthalmol. 2023;58:171-178;
  2. Langley G, Moen RD, Nolan KM, et al. The improvement guide: a practical approach to enhancing organizational performance, 2nd ed. Jossey-Bass, San Francisco, CA, 2009.
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