Documenting the subjective patient experience of first versus second eye during immediately sequential bilateral cataract surgery

Purpose: During delayed sequential bilateral cataract surgery patients tend to have subjectively inferior experiences during the second eye surgery than the first eye surgery. Our study investigated if this phenomenon would still occur during immediate sequential bilateral cataract (ISBCS) as both operations are performed within the same surgical visit. Setting: To investigate this, we enrolled patients undergoing ISBCS at a multi-surgeon ophthalmic surgical center into our study. Design: Our study used a survey-based prospective design to measure the experience of these patients with ISBCS. The first eye which underwent surgery was randomized. Methods: Patients of the center undergoing routine cataract surgery who enrolled in the study completed a questionnaire immediately after surgery to describe their surgical experience for each eye. Survey questions measured patient pain, discomfort or pressure, comfort, relaxation, estimated length of surgery and predicted visual outcome. Results: Patient reported level of pain during the second eye surgery was significantly greater than for the first eye (p<0.001). Furthermore, the order of surgery was found to be a strong predictor of patient reported pain (p<0.001), more so than surgical length (p<0.008), additional anesthesia (p<0.35), patient age (p<0.44) or patient sex (p<0.88). Overall, surgery during the first eye was reported as more comfortable (p<0.001) and shorter in duration (p<0.001) while discomfort and pressure were reported as worse for the second eye (p<0.001). Conclusions: Understanding differential experiences between eyes can help surgeons when counselling patients regarding expectations for ISBCS and related visual outcomes.