Quiz: Which eye do you fix first?

This patient needs surgery on both eyes. The right eye has a cataract which is limiting the vision to 20/80 and the left eye had complications from pråçior procedures and it sees 20/40 but with terrible glare. Which eye do you fix first?

There are two different philosophies:

  1. fix the eye with complications first and then restore it to good / acceptable vision, then you can operate on the second eye
  2. operate on the eye with better visual potential and a more straightforward surgery first, then attempt a revision of the eye with complications

If you operate on the eye with less visual potential, then you run the risk of making the patient dissatisfied with the outcome and then declining to have surgery on the other eye. The patient may think, “the eye you fixed still doesn’t see that well, so now I’m afraid to have any surgery on my other eye.”

If you fix the eye with better visual potential first, then the patient will know that you are able to provide great visual outcomes and when it’s time for the revision surgery of the other eye, you’ll tell the patient that it won’t be as good as the other eye and yet the patient will say, “it’s ok, try your best, anything will be better.”

The patient is best served by you giving the best visual outcome and that often means operating on the eye with better visual potential, lower risks, and a smoother procedure.

In this case, I did surgery on the virgin right eye first. I was careful to give the surgeon who did the other eye the benefit of the doubt. Everything went great and the patient is seeing 20/20.

Now we will plan the revision surgery of the other eye, which won’t be easy because the sulcus IOL must be explanted, then an anterior vitrectomy performed, then the new IOL must be fixed in place, and finally a pupilloplasty is required.

Click below to learn this important surgical concept from the video:

1 Comment

  1. right eye first. left eye should be best left for the second surgery. Patient is sure to be more comfortable as there is an eye with good vision. his cooperation and compliance will be much better the second time.

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