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What is OMIC’s position regarding immediately sequential bilateral cataract surgery (ISBCS)?

Updated 6/5/2014

As the American Academy of Ophthalmology states in their Preferred Practice Pattern, “Cataract in the Adult Eye,” immediately sequential bilateral cataract surgery may be indicated in certain circumstances, but the advantages and disadvantages must be carefully weighed against the risk of potentially blinding complications such as bilateral endophthalmitis before proceeding with same-day surgery. OMIC shares this conservative position. Recognizing that ISBCS may be in the best interest of the patient because of health concerns or anesthesia risks that make multiple surgeries more risky or because unusually long travel distances create an undue hardship for the patient that might compromise adequate follow-up care, OMIC has not implemented underwriting requirements, policy conditions, or exclusions that prohibit the performance of immediately sequential bilateral cataract surgery. OMIC does, however, encourage insureds considering the performance of ISBCS to contact risk management staff at (800) 562-6642, option 4, before proceeding. OMIC’s risk managers can provide advice and assistance in developing appropriate protocols for determining when ISBCS is indicated, obtaining adequate informed consent that addresses the increased risks of ISBCS, implementing safeguards to reduce the risk of bilateral endophthalmitis or other complications, and proper medical record documentation.

While OMIC has not established underwriting requirements for immediately sequential bilateral cataract surgery, the company has implemented requirements for immediately sequential bilateral intraocular refractive surgery procedures (RLE and phakic implants):

  • Patients undergoing immediately sequential bilateral intraocular refractive surgery (ISBIRS) must be at low risk for surgical complications. Treatment of both eyes on the same day is not permitted for “complex” surgical cases, such as in patients with amblyopia, pseudoexfoliation syndrome, complicated cataracts (poor dilation or brunescent cataracts), high hyperopes with axial length <20.0 mm, eyes with previous ocular trauma, or eyes with active macular SRNVM with leakage or significant diabetic retinopathy, or in patients at higher risk of infection, such as patients who are immunocompromised or have poorly controlled diabetes.
  • ISBIRS is not recommended in patients for whom there is a greater than normal risk of having difficulties calculating or selecting the appropriate IOL power. These types of patients include those who have previously undergone refractive surgery (e.g., LASIK, PRK, CK, and RK), have significant corneal scarring or keratoconus, have extremely long or short axial lengths, or have conditions that make it difficult to cooperate for the Optical or Ultrasonic Biometry (e.g., nystagmus or dementia).
  • Immediately sequential bilateral patients must read and sign the applicable Addendum for Bilateral Same Day Surgery developed by OMIC or an equivalent bilateral consent addendum.  Click here to access the Addendum for Bilateral Same Day Refractive Lens Exchange Surgery or here to access the Addendum for Bilateral Same Day Phakic Implant Surgery.
  • The physician must develop and follow appropriate protocols to reduce the risks for right-left eye errors and errors in IOL insertion.
  • There must be complete aseptic separation of the first and second eye surgeries, including use of separate instrument trays that have undergone separate sterilization cycles; complete, repeat surgical scrub and draping; and separate intraocular irrigating fluids and drops with different lot numbers.
  • Antibiotics must be appropriately administered at sufficient dosages to reduce the risk of endophthalmitis. Consideration should be given to use of intracameral antibiotics, either in the irrigating solution or injected into the anterior chamber.
  • Any complication with the first eye must be resolved before proceeding with surgery on the second eye.
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