Cataracts, are we ready to operate eyes together? the surgery that halves waits and divides doctors

Imagine entering the operating theatre with blurred vision and coming out, after a few hours, with both eyes ready to rediscover the colours and details of the world. Without having to come back a second time, without doubling the stress of waiting, hospital trips and recovery time. Simultaneous Bilateral Cataract Surgery (SBCS) is no longer a futuristic idea, but an established reality in many European and North American countries. In Italia, however, the issue still inflames a heated debate between those who see in this practice the solution to the collapse of waiting lists and those who, guided by historical prudence, fear the risk - albeit infinitesimal - of infectious complications and the labyrinth of legal responsibilities.

An intense discussion between specialists took place in Rome a few days ago during the 'Practical Ophthalmology' event hosted by Clio Ophthalmology. The first major argument in favour of 'double intervention' is of an organisational nature. With over 650,000 operations a year, cataracts are the most frequently performed operation in Italia. And the demographic curve means that by 2030 it is expected to reach the figure of one million operations per year. This has, and will have, a considerable impact on waiting lists which, already today, in some regions, can exceed two years and drive many patients to turn to the private sector.

Operating both eyes in the same session would in fact mean halving the number of visits to the operating theatre for this pathology. As emphasised by Augusto Pocobelli, Director of the Neuroscience Department and Ophthalmology Unit of the Azienda Ospedaliera San Giovanni Addolorata in Rome: "Ophthalmology has changed radically thanks to technology, but routine is the enemy of quality. We must invest in what we do not yet see implemented, managing resources with a vision that prioritises the efficiency of the public pathway and the reduction of downtime'. Reducing the pressure on hospitals is not only an economic benefit, but an act of civilisation towards an increasingly elderly population that needs quick answers.

Beyond the numbers, there are people's lives. Undergoing two separate surgeries means double the psychophysical stress, cycles of antibiotic eye drops and dependence on family members for accompaniment. Bilateral surgery restores a balanced visual autonomy already after 24 hours, avoiding that annoying imbalance (anisometropia) that occurs when one eye sees well and the other is still opaque. Professor Leopoldo Spadea, Director of the UOC of Ophthalmology at the Policlinico Umberto I in Rome (La Sapienza University), emphasises the patient's centrality: "Restoring complete binocular vision in a single act means restoring the patient's immediate autonomy, a crucial factor for quality of life, especially for those who live alone or have motor difficulties". According to the specialist, however, the careful selection of the ideal candidate remains the fundamental pillar for the success of this approach: "The risks are very low, around one case per 4,000 operations. But on young patients, let's say still of working age, it's a risk I wouldn't take".

Italian resistance stems mainly from the fear of endophthalmitis, a serious eye infection that, although very rare, if contracted bilaterally, can lead to even blindness. However, international protocols provide for the complete separation of instruments, drugs and even teams for the two eyes, treating them as two separate surgeries performed one after the other. Guido Lesnoni, an eye surgery specialist and one of the promoters of the comparison, points out how technology is an increasingly solid ally for safety: "Today we work with 3D systems that allow us to operate by looking at very high resolution panoramic screens, almost physically entering the eye. This millimetric precision, combined with strict sterilisation protocols, drastically reduces error margins and makes bilateral surgery a safe and repeatable procedure'.