An Investigation into the Low Use Rate of Immediate Sequential Bilateral Cataract Surgeries in the U.S.

Extending an earlier paper, we investigated why immediate sequential bilateral cataract surgery (ISBCS) rates in the United States (US) are low. Data came from 44,295 bilateral cataract surgeries (BCS) in the US Department of Veterans Affairs (VA) between 2004 through 2023. Advanced analytics were used to estimate independent associations between clinical and non-clinical factors on ISBCS use rates both pre- and during the pandemic. The relative ISBCS use rate increased 231% with the pandemic independently of changes in other factors, though the absolute rate remained low (4%). Clinical factors decreasing ISBCS use rates (ocular comorbidity and facility BCS volume) became less important during the pandemic, while non-clinical factors (travel burden) increasing ISBCS use rates up become more important. Low use rates in the VA, where most physicians are salaried, come from surgeons and patients who act as if ISBCS pose substantive additional risk to safety and effectiveness.