Ophthalmologists’ Perspectives on Immediate Sequential Bilateral Cataract Surgery (ISBCS): Attitudes, Practices, and Barriers in a Rapidly Growing Arab Economy

Samar A Al-Swailem,1 Ahmed Mousa,2 Abdulrahman AlMatrafi,3 Sara AlHilali1 1Anterior Segment Division, King Khaled Eye Specialist Hospital and Research Center, Riyadh, Saudi Arabia; 2Research Department, King Khaled Eye Specialist Hospital and Research Center, Riyadh, Saudi Arabia; 3Department of Ophthalmology, Alnoor Specialist Hospital, Makkah, Saudi ArabiaCorrespondence: Sara AlHilali, Anterior segment division, King Khaled Eye Specialist Hospital and Research Center, P.O.Box 7191, Riyadh, 11462, Saudi Arabia, Tel +966544017155, Email [email protected]: To our knowledge, there is very little research on “Immediate Sequential Bilateral Cataract Surgery” (ISBCS) among ophthalmologists in the Arab countries. This study aimed to assess the attitudes, practices, and barriers related to ISBCS among board-certified ophthalmologists in a fast-growing Arab economy.Methods: A cross-sectional study was conducted using a validated electronic questionnaire distributed to ophthalmologists practicing cataract and intraocular lens (IOL) surgery in Saudi Arabia. The survey was open from September 22 to October 21, 2024. The questionnaire included 25 specific questions divided into four domains: benefits and importance, controlling factors, surgeons’ perspectives and selectivity, and reasons for adopting or rejecting ISBCS. Responses were collected via email, WhatsApp, and LinkedIn and analyzed based on the questionnaire planned structure. Descriptive statistics were used for analysis.Results: A total of 95 ophthalmologists participated, 73 (76.8%) male and 22 (23.2%) female. The majority (60%) had been practicing for more than 10 years, and 69.5% worked in government hospitals. The ISBCS was actively practiced by 17.9%, while 76.8% had never performed ISBCS, and 5.3% had previously practiced but discontinued. The main benefits of ISBCS reported included fewer hospital visits, faster visual rehabilitation, and reduced costs. The primary barriers were concerns about bilateral endophthalmitis, medico-legal risks, and refractive surprises. Some non-practicing ophthalmologists expressed willingness to adopt ISBCS under specific conditions, such as cases requiring general anesthesia or congenital cataracts.Conclusion: ISBCS remains underutilized among ophthalmologists in Saudi Arabia due to safety concerns and institutional policies. However, many practitioners recognize its potential benefits and may consider its adoption under specific conditions. Further research is needed to evaluate clinical outcomes, patient perspectives, patient satisfaction, opportunity cost, and cost-effectiveness to facilitate broader acceptance of ISBCS in this region.Keywords: cataract surgery, ISBCS, ophthalmologists’ attitude, Saudi Arabia