How long between eyes in staged surgery?

Most surgeons recommend 1 to 4 weeks between procedures. This gives the first eye time to stabilise, allows the surgeon to confirm the visual outcome, and provides the opportunity to fine-tune the lens calculation for the second eye if needed. Some centres with rapid-access follow-up protocols may do the second eye in as little as a few days.

Will I be effectively blind between the two procedures?

No — you will not be blind. Most people can function reasonably well with one treated eye, especially if the untreated eye has a partial cataract rather than a dense one. However, vision between the two procedures may feel unbalanced, particularly for depth perception and activities like driving. Your surgeon will advise on driving and work restrictions based on your specific visual status.

Does Medicare cover both eyes?

Yes. Medicare provides a rebate for cataract surgery on each eye separately, regardless of whether the procedures occur on the same day or weeks apart. In the private system, gap fees may apply and should be discussed with your surgeon and health insurer before proceeding.

Can the result of the first eye change what lens goes in the second?

Absolutely — and this is one of the main advantages of staged surgery. Modern biometry is highly accurate, but occasionally the measured result differs slightly from the predicted outcome. With staged surgery, your surgeon can review how the first eye responded and adjust the IOL power calculation for the second eye accordingly, further optimising the result.

Can You Have Cataract Surgery in Both Eyes at the Same Time?

Quick Answer

Yes — but most Australian ophthalmologists default to staged surgery(one eye at a time, 1–4 weeks apart). Same-day surgery on both eyes, known as Immediately Sequential Bilateral Cataract Surgery (ISBCS), is a safe and validated option for carefully selected patients, but it is not appropriate for everyone.

The Two Approaches to Bilateral Cataract Surgery

When cataracts affect both eyes — which is very common — your surgeon will recommend one of two timing strategies:

Staged (sequential) surgery: The first eye is treated, then the second follows after an interval of 1–4 weeks. This is the most widely practised approach in Australia.
ISBCS (Immediately Sequential Bilateral Cataract Surgery): Both eyes are treated on the same day, back to back, using completely separate and sterile instrument sets for each eye — not a single, continuous procedure. Each eye is treated as a fully independent operation.

Both approaches use the same surgical technique — phacoemulsification with intraocular lens (IOL) implantation — and both can deliver excellent visual outcomes. The choice between them depends on your eye health, general health, lifestyle needs, and surgeon assessment.

Same-Day Surgery (ISBCS): How It Works

ISBCS is not as uncommon as many patients think. It has been widely practised in Scandinavia for decades, and evidence from large studies confirms it is safe when performed with proper protocols. Key features include:

• Completely separate sterile instrument sets for each eye
• A “pause and reset” between eyes to re-establish a sterile field
• Different batches of intracameral antibiotics and viscoelastic for each eye
• Topical anaesthetic (eye drops) for both eyes — no general anaesthetic required
• One hospital admission, one recovery period, one anaesthetist fee

The primary concern with ISBCS is that, theoretically, a systemic contamination such as toxic anterior segment syndrome (TASS) or endophthalmitis could affect both eyes simultaneously. Strict protocol adherence reduces this risk to an extremely low level — comparable to performing two staged procedures.

Who is ISBCS best suited for?

Patients with bilateral dense cataracts, good general and ocular health, no history of glaucoma or retinal disease, and similar expected lens powers in both eyes are typically the best candidates for same-day bilateral surgery.

Staged Surgery: The Case for One Eye at a Time

Staged surgery remains the standard of care at most Australian ophthalmology practices. The interval between eyes — typically 1 to 4 weeks — serves several important purposes:

IOL power verification: The actual refractive outcome of the first eye can be measured before the second eye’s lens power is finalised, allowing fine-tuning that improves accuracy.
Risk containment: If a complication such as infection occurs in the first eye, the second is protected and can be rescheduled once the issue is resolved.
Patient reassurance: Many patients feel more comfortable experiencing the procedure with one eye first before committing to the second, particularly if anxious about surgery.
Complex eye conditions: Patients with high myopia, high hyperopia, glaucoma, macular degeneration, previous corneal or retinal surgery, or only one functional eye are generally advised to proceed with staged surgery.

1–4 Weeks

Typical gap between eyes in staged surgery

10–15 min

Approximate duration of each eye’s procedure

Very Rare

Risk of serious infection with modern techniques

Side-by-Side Comparison

	Same-Day (ISBCS)	Staged (Sequential)
Timing	Both eyes treated on the same day with separate sterile setups	Second eye done 1–4 weeks after the first
Anaesthetic visits	One visit, one anaesthetic	Two separate visits, two separate anaesthetics
Recovery	One combined recovery period	Two separate recovery periods
Vision between procedures	No period of imbalanced vision between eyes	Temporary imbalance while one eye is treated and the other is not
IOL fine-tuning	No opportunity to adjust second eye based on first outcome	Second eye’s lens power can be refined using first eye’s result
Infection risk	Very low, but theoretically could affect both eyes simultaneously	Infection in one eye cannot directly affect the other
Best for	Healthy eyes, bilateral dense cataracts, patients who cannot undergo multiple procedures	High refractive error, glaucoma, macular disease, previous eye surgery, complex cases

Not sure which approach suits your eyes?

A comprehensive pre-operative assessment will determine the safest and most appropriate timing for your surgery.

Explore Cataract Surgery Book a Consultation

Who Is Each Approach Suited For?

Your ophthalmologist will assess a range of clinical and personal factors to determine the most appropriate approach for you.

ISBCS may be appropriate if you have:

• Bilateral cataracts of similar density
• Similar expected IOL powers in both eyes
• No significant other ocular pathology (no glaucoma, no retinal disease)
• A general health condition that makes multiple procedures difficult (e.g. difficulty lying flat, significant anxiety with multiple hospital admissions)
• A strong preference for faster bilateral rehabilitation

Staged surgery is generally preferred if you have:

• High myopia or high hyperopia (where IOL calculation is more demanding)
• Co-existing glaucoma, macular degeneration, or retinal disease
• Had previous corneal refractive surgery (e.g. LASIK)
• Only one functional eye
• A preference to “try one eye first”

Important: ISBCS is not for everyone

Even if you meet the general criteria for ISBCS, the final decision rests with your surgeon’s assessment of your individual eyes and circumstances. Never feel pressured into a same-day approach if staged surgery feels more appropriate for you.

In Summary

Both eyes can be treated on the same day under the right conditions, and ISBCS has a strong safety record when performed with strict protocols. However, staged surgery remains the most common and most flexible approach in Australia, offering the added advantage of lens power refinement and isolated risk management. The best approach for you depends on your eye health, general health, and personal preferences — all of which your ophthalmologist will discuss with you at your pre-operative assessment.

Frequently Asked Questions

Yes, for carefully selected patients. Immediately Sequential Bilateral Cataract Surgery (ISBCS) uses completely separate sterile setups and instrument sets for each eye — treating them as two independent procedures performed the same day. Australian and international guidelines support ISBCS for appropriate candidates. The risk of a serious complication, such as infection (endophthalmitis), is extremely low with modern techniques.

Written by

Dr Parth Shah

Dr Parth Shah is a subspecialty-trained Canberra ophthalmologist with expertise in cataract surgery, paediatric eye care and strabismus surgery.