- Medically Reviewed by: Mr Mfazo Hove, Consultant Ophthalmic Surgeon
- Author: Mr Mfazo Hove
- Published: November 3, 2026
- Last Updated: November 2, 2026
TL;DR: Yes, cataract surgery can be performed on both eyes on the same day when your eyes and circumstances are suitable. It offers one recovery period rather than two, but both eyes recover together and the first eye’s result cannot be used to fine-tune the lens for the second. Each eye is treated as a separate operation, with strict sterile separation between procedures.
I began performing same-day bilateral cataract surgery in 2016, and I offered it from the first day of my private practice in 2017, before it became Blue Fin Vision®. It has been our default ever since. I have also been on the other side of the microscope: I had both of my own eyes operated on the same day.
The formal name is immediate sequential bilateral cataract surgery, or ISBCS. This article explains what it involves, what patients gain, how safety is protected between the two eyes, when I stop after the first eye, and what the evidence shows. It also explains why the question has become a live one in the NHS this year.
Both of My Own Eyes, on the Same Day
In April 2024 I had lens surgery on both eyes on the same day, with the same trifocal lenses I implant for many of my patients. These are artificial lenses designed to provide vision at near, intermediate and far distances. I chose same-day surgery for exactly the reasons I recommend it: one operation day, one recovery period, and no weeks spent with one eye treated and the other not.
Being the patient changed how I talk about it. I know what it is like to lie on the theatre trolley knowing the second eye is next, and I know what it is like to go home with both eyes recovering together. When patients ask whether I would have it done myself, I can give them a straight answer: I did.
On the day of my own surgery, when both of my eyes were operated on.
What Happens in Theatre
Same-day bilateral surgery is not one operation on two eyes. It is two complete operations, one after the other, in the same theatre session. The second operation is treated as if it were a different patient’s.
Once the first eye is finished, theatre is reset. I re-scrub and put on a fresh gown and gloves. The second eye has its own sterile instrument set, its own fluids and medicines, new drapes and separately prepared consumables, so that nothing used on the first eye touches the second.
This principle of aseptic separation, keeping the sterile equipment and preparation for each eye entirely separate, is the foundation of UK guidance from the Royal College of Ophthalmologists and the UK and Ireland Society of Cataract and Refractive Surgeons.¹
In my hands, each eye typically takes around five minutes of operating time, with around five minutes between eyes for the reset.
At Blue Fin Vision®, I bring two of the planned lenses and a back-up lens for every eye on the list, so a change of plan in theatre never depends on what happens to be in stock.
What Patients Gain
The benefit patients feel most is simple: one recovery period, without the weeks of unequal vision between operations.
After first-eye surgery, many people spend weeks or months with one eye corrected and the other still cloudy, and often strongly short- or long-sighted. This imbalance, called anisometropia, can make old glasses unusable, depth judgement poor and everyday tasks tiring.
In a Swedish randomised clinical study, patients who had both eyes treated on the same day reported better visual function in daily life during the period when the comparison group was still waiting for their second eye.²
Patients also gain one pre-operative pathway, one trip to theatre, fewer follow-up visits, fewer lifts needed from family, and one post-operative drop timetable covering both eyes.
There are trade-offs, and I discuss them with every patient:
- Both eyes will be recovering at the same time. Vision may be blurred in both, particularly early on, and recovery varies from person to person. Some people need additional help at home during this period.
- The result of the first eye cannot be used to fine-tune the lens for the second.
- A serious infection can affect both eyes, although this is extremely rare.
When I Stop After the First Eye
Same-day surgery is a plan, not a commitment that overrides judgement. I do not operate on the second eye if:
- There has been any complication during the first operation, such as a tear in the lens capsule, the thin membrane surrounding the natural lens.
- Anything about the first eye has not gone exactly to plan, including an unexpected finding that would change my thinking about the second.
- The patient is unwell, distressed or uncomfortable, or simply wants to stop.
- Any part of the reset between eyes cannot be completed properly.
If any of those apply, the second eye is booked for another day. That is not a failure of the plan; it is the plan working.
Am I Suitable?
I discuss same-day surgery with every patient who needs both cataracts treated. We then decide together whether it suits their eyes and their circumstances.
The National Institute for Health and Care Excellence (NICE) says same-day bilateral surgery should be considered for people at low risk of complications during and after surgery, and for people who need general anaesthesia where the anaesthetic carries an increased risk of complications or distress.³
Whether that applies to you depends on your eye examination, measurements, medical history and the support you have at home.
Situations where delaying the second eye may be wiser include:
- Active inflammation or infection.
- Eye conditions that substantially raise the risk of a complicated operation.
- Measurements that make lens power calculation unusually uncertain.
- Home circumstances where blurred vision in both eyes early on would leave someone without enough support.
Some patients simply prefer one eye at a time, and that is always respected.
Why This Matters Now: The 2026 National Cataract Audit
The Royal College of Ophthalmologists’ 2026 National Cataract Audit, published in September 2026 and covering surgery from April 2024 to March 2025, includes a dedicated section on same-day bilateral surgery.⁴
It reports that uptake has continued to rise, with more than 1% of patients who had not had cataract surgery in either eye now choosing same-day bilateral surgery. It also notes that the UK still offers it far less than many comparable health systems.
The Royal College now asks cataract services to review their own same-day bilateral rates and to prepare patient information leaflets, consent forms and theatre protocols for it.⁴ To me, this signals a shift in the national conversation: not simply whether to offer same-day surgery, but how to offer it well to suitable patients.
That is a big change. An earlier analysis of national audit data found that between 2010 and 2018 just 1,073 patients had same-day bilateral surgery, compared with 248,341 who had their eyes done on separate days, and those who did have it were often patients needing general anaesthesia or unable to lie flat.⁵
A 2020 survey found that only 13.9% of responding UK ophthalmologists were offering it.⁶
Against that background, offering it as standard since 2017 has been unusual. It no longer needs to be.
What the Evidence Shows
Randomised Trials
The Helsinki randomised trial of around 500 patients found comparable visual outcomes and complication rates between same-day and delayed bilateral surgery.⁷
The largest modern trial, BICAT-NL, was published in The Lancet in 2023.⁸ It randomised 865 patients in ten Dutch hospitals. It enrolled patients expected to have uncomplicated surgery and without a high risk of infection or refractive surprise, meaning a result that differs unexpectedly from the planned focusing outcome. This is worth bearing in mind when applying its results.
The trial assessed how closely the second eye reached its target refraction, the intended focusing result after surgery. This is measured in dioptres, the units used to describe lens power and glasses prescriptions.
Outcome (BICAT-NL) | Same Day | Separate Days |
|---|---|---|
Second eye within 1.0 dioptre of target refraction | 97% | 98% |
Endophthalmitis, a serious infection inside the eye | None | None |
Patients reporting troublesome imbalance between operations | 0 | 13 |
Societal cost per patient | €403 lower with same-day surgery | Comparison group |
A Cochrane systematic review, which brings together and assesses research studies, was published in 2022. It found that the type of surgery probably makes little or no difference to patient-reported outcomes one to three months after surgery, found no difference in the proportion of eyes reaching their refractive target, and reported lower costs for same-day surgery across the economic studies.⁹
Infection: The Question Everyone Asks
The concern most often raised is endophthalmitis, a rare but serious infection inside the eye, occurring in both eyes at once. The evidence is reassuring, and it is also honest about the risk not being zero.
A large international survey covering 95,606 operated eyes found no case of bilateral simultaneous endophthalmitis. Most bilateral cases reported over several decades were associated with breaches of aseptic protocol, the procedures used to maintain sterile conditions.¹⁰
An analysis of more than 5.5 million patients in the American Academy of Ophthalmology IRIS Registry found similar infection rates after same-day surgery (0.059%) and delayed or one-eye surgery (0.056%); all seven bilateral infections in that dataset occurred in patients who had their eyes done on separate days.¹¹
The Swedish National Cataract Register, one of the most complete datasets in the world, found infection after same-day surgery in about 1 in 6,600 operations, lower than after single-eye surgery. It also recorded one patient with infection in both eyes, around 1 in 46,000 same-day patients, and the case review found no documented irregularity to explain it.¹²
In Denmark, three patients operated on the same day at one clinic developed infection in both eyes; the same bacterial strain was found across the eyes, pointing to a systematic breach of sterility on that day.¹³
The lesson from all of this is consistent. The risk is very low, and it is kept low by doing every part of the reset properly, every time.
Intracameral antibiotics, antibiotics placed inside the eye during surgery, are standard infection prophylaxis, meaning treatment to help prevent infection, in cataract surgery. They are used in every eye I operate on.
Refractive Accuracy
With delayed surgery, the surgeon can see how the first eye turned out before choosing the second lens. With same-day surgery, that information is not available.
An analysis of nearly two million patients in the IRIS Registry found slightly lower average vision after same-day surgery, a difference of around two to three letters on a chart, which the authors noted was small and may not be clinically relevant for most patients.¹⁴
In BICAT-NL, refractive accuracy in the second eye was effectively identical between groups.⁸
My answer to refractive risk is high-quality biometry, measurements of the eye used to calculate the required lens power, careful lens selection by the operating surgeon, and a conversation in advance about eyes whose measurements are unusual.
For those eyes, delayed surgery is sometimes the better choice, and I say so.
Theatre Efficiency
Same-day surgery also helps services treat more people. Economic modelling based on NHS time and motion data suggested routine same-day bilateral surgery could reduce the time needed for two cataract operations by an average of 16%.¹⁵
An observational study of real NHS lists found that two consecutive single-eye operations took 48.7 minutes on average, compared with 42.2 minutes for one same-day bilateral case.¹⁶
The SpaMedica Transition, and the Patients on My Lists
At Blue Fin Vision®, same-day surgery is discussed at consultation, so patients have time to think about it, and suitable patients are consented for it then. There is no transition.
The NHS lists I operate on for SpaMedica are different, and I can only describe them as I experience them. On those lists, I now offer suitable patients the option of having both eyes treated on the same day.
The usual pathway is changing, and I do not run the pre-operative process, so during this changeover some patients on my lists have been referred for surgery on both eyes but booked for one.
Some of them will have heard about same-day surgery before they arrive. Others may hear about it for the first time on the day of surgery.
For these patients, the offer is made on the day. If a patient would like both eyes treated, I come and see them, explain what is specific to same-day surgery and take consent for both eyes myself.
That discussion covers the fact that both eyes will be recovering together, that the first eye’s result cannot guide the second lens, that they may need more help at home early on, and what the risks are.
I then operate on the first eye, and go on to the second only if the first operation has gone to plan.
If a patient would rather keep their original booking and have the second eye on another date, that booking stands, with nothing lost.
Crucially, agreeing on the day is not a point of no return. Patients keep the right to decline the second operation at every stage, including after the first eye is finished and while theatre is being reset. Saying no is as easy as saying yes, and it stays that way throughout.
When the choice is explained this way, many patients choose both eyes. Here are some of them, photographed in theatre after their surgery on my SpaMedica NHS lists.
Photographs published with each patient’s written consent.
Our Outcomes
Published research tells you what is achievable across many surgeons. It does not tell you about the surgeon in front of you, which is why we publish our own figures.
Blue Fin Vision®’s published figures for my 2024 to 2025 cataract audit show a posterior capsule rupture rate of 0.20% across more than 5,600 operations, with the capsule intact in 99.8%. Posterior capsule rupture means a tear in the back of the thin membrane surrounding the natural lens.
Posterior capsule rupture is the complication most widely used to benchmark cataract surgery, and for the same year the national observed rate was 0.70%.⁴
These are observed rates and do not, by themselves, account for differences in case complexity. My figures cover all my cataract surgery that year, not same-day bilateral cases alone.
Clinical Takeaway
For appropriately selected patients, same-day surgery, performed as two fully separate operations with strict aseptic separation, offers one recovery period instead of two.
Studies have found comparable visual results and similar complication rates. The rare risk of a serious problem in both eyes remains part of the consent discussion. It should be offered, explained and chosen, never assumed.
And the last word belongs to the patients who listen to all of this and decide they would rather come back for their second eye. They are making exactly the kind of informed choice this article is about. My job is to make sure every patient can choose either way, and that both answers are equally welcome.
References
- The Royal College of Ophthalmologists, UK and Ireland Society of Cataract and Refractive Surgeons. Immediate Sequential Bilateral Cataract Surgery (ISBCS) during COVID recovery: RCOphth/UKISCRS rapid advice document. London: RCOphth; 2020.
- Lundström M, Albrecht S, Nilsson M, Aström B. Benefit to patients of bilateral same-day cataract extraction: randomized clinical study. J Cataract Refract Surg. 2006;32(5):826-830.
- National Institute for Health and Care Excellence. Cataracts in adults: management. NICE guideline NG77. London: NICE; 2017.
- The Royal College of Ophthalmologists. National Ophthalmology Database Audit: Ninth Annual Report of the National Cataract Audit (audit period 1 April 2024 to 31 March 2025). London: RCOphth; 2026.
- Buchan JC, Donachie PHJ, Cassels-Brown A, Liu C, Pyott A, Yip JLY, Zarei-Ghanavati M, Sparrow JM. The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: Report 7, immediate sequential bilateral cataract surgery in the UK: current practice and patient selection. Eye (Lond). 2020;34(10):1866-1874.
- Lee E, Balasingam B, Mills EC, Zarei-Ghanavati M, Liu C. A survey exploring ophthalmologists’ attitudes and beliefs in performing immediately sequential bilateral cataract surgery in the United Kingdom. BMC Ophthalmol. 2020;20(1):210.
- Sarikkola AU, Uusitalo RJ, Hellstedt T, Ess SL, Leivo T, Kivelä T. Simultaneous bilateral versus sequential bilateral cataract surgery: Helsinki Simultaneous Bilateral Cataract Surgery Study Report 1. J Cataract Refract Surg. 2011;37(6):992-1002.
- Spekreijse L, Simons R, Winkens B, van den Biggelaar F, Dirksen C, Bartels M, de Crom R, Goslings O, Joosse M, Kasanardjo J, Lansink P, Ponsioen T, Reus N, Schouten J, Nuijts R. Safety, effectiveness, and cost-effectiveness of immediate versus delayed sequential bilateral cataract surgery in the Netherlands (BICAT-NL study): a multicentre, non-inferiority, randomised controlled trial. Lancet. 2023;401(10392):1951-1962.
- Dickman MM, Spekreijse LS, Winkens B, Schouten JSAG, Simons RWP, Dirksen CD, Nuijts RMMA. Immediate sequential bilateral surgery versus delayed sequential bilateral surgery for cataracts. Cochrane Database Syst Rev. 2022;4(4):CD013270.
- Arshinoff SA, Bastianelli PA. Incidence of postoperative endophthalmitis after immediate sequential bilateral cataract surgery. J Cataract Refract Surg. 2011;37(12):2105-2114.
- Lacy M, Kung TH, Owen JP, Yanagihara RT, Blazes M, Pershing S, Hyman LG, Van Gelder RN, Lee AY, Lee CS; IRIS Registry Analytic Center Consortium. Endophthalmitis rate in immediately sequential versus delayed sequential bilateral cataract surgery within the Intelligent Research in Sight (IRIS) Registry data. Ophthalmology. 2022;129(2):129-138.
- Friling E, Johansson B, Lundström M, Montan P. Postoperative endophthalmitis in immediate sequential bilateral cataract surgery: a nationwide registry study. Ophthalmology. 2022;129(1):26-34.
- Bjerager J, Leegaard Holm DM, Holm L, Faber C, Bate A, Christakopoulos C, Bjerrum SS. Outbreak of bilateral endophthalmitis after immediate sequential bilateral cataract surgery. JAMA Ophthalmol. 2023;141(11):1075-1078.
- Owen JP, Blazes M, Lacy M, Yanagihara RT, Van Gelder RN, Lee AY, Lee CS; IRIS Registry Analytic Center Consortium. Refractive outcomes after immediate sequential vs delayed sequential bilateral cataract surgery. JAMA Ophthalmol. 2021;139(8):876-885.
- O’Brart DPS, Roberts H, Naderi K, Gormley J. Economic modelling of immediately sequential bilateral cataract surgery (ISBCS) in the National Health Service based on possible improvements in surgical efficiency. BMJ Open Ophthalmol. 2020;5(1):e000426.
- Naderi K, Lam CFJ, Low S, Bhogal M, Jameel A, Theodoraki K, Lai L, Onrubia Garcia L, Roberts H, Robbie S, O’Brart D. Time and motion studies to assess surgical productivity in cataract theatre lists within the National Health Service: immediate sequential bilateral cataract surgery versus delayed sequential bilateral cataract surgery. Eye (Lond). 2023;37(18):3751-3756.
ABOUT THE AUTHOR
Mr Mfazo Hove
MBChB MD FRCOphth CertLRS
Consultant Ophthalmic Surgeon | Founder and Medical Director, Blue Fin Vision®
Mr Mfazo Hove is a Consultant Ophthalmic Surgeon with more than two decades of experience across NHS and private practice and more than 57,000 ophthalmic procedures performed. He trained for six and a half years at Moorfields Eye Hospital and served for five years as an NHS consultant at the Western Eye Hospital, Imperial College Healthcare NHS Trust.
He specialises in cataract surgery, refractive lens replacement, laser vision correction and implantable Collamer lenses (ICL). He is the founder and Medical Director of Blue Fin Vision®, a private ophthalmology group providing consultant-delivered care across London, Hertfordshire and Essex. His cataract surgery outcomes are publicly reported through the National Ophthalmology Database.
A ZEISS Key Opinion Leader and international speaker, Mr Hove is a contributing author to The Ophthalmologist. His writing examines how clinical governance and the organisation of ophthalmic services shape patients’ experiences and outcomes, with a focus on transparent outcome reporting, surgical training and long-term accountability for patient care.
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