Evaluating the benefits of second-eye cataract surgery among the elderly Takuro Ishikawa, BA, Ediriweera Desapriya, PhD, Maneesh Puri, MB BS, John M. Kerr, BSc, D. Sesath Hewapathirane, PhD, Ian Pike, PhD The aim of this systematic review was to synthesize and appraise the evidence of benefits of second- eye cataract extraction for visual function, patient-reported quality of life, falls, and driving ability among the elderly. We conducted a comprehensive search in MEDLINE using “surgery,” “cataract extraction,” “second eye,” and “bilateral.” Ten studies met the inclusion and quality criteria. We found “moderate” evidence supporting improvement in stereopsis, stereoacuity, and anisometropia over and above the benefits of first-eye surgery. We also found “moderate” evidence supporting improve- ment in visual acuity, contrast sensitivity, and self-reported visual functioning. Studies included in the review do not provide definitive evidence of second-eye surgery benefits on health-related quality of life, visual fields, falls prevention, and driving performance. However, the heterogeneity of outcome measures and the limited number of studies likely contributed to our findings. The findings have im- plications for clinicians and policymakers in the health-care industry and emphasize the need for additional trials examining this important and widely performed clinical procedure. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. J Cataract Refract Surg 2013; 39:1593–1603 Q 2013 ASCRS and ESCRS Supplemental material available at www.jcrsjournal.org. Age-related cataracts are the leading cause of visual impairment among the elderly 1 and are associated with a higher risk for falls 2 and motor vehicle collisions 3,4 in this population. With the increase in life expectancy among the general population and successful initiatives to eliminate avoidable blindness globally (eg, VISION 2020), the number of cataract surgeries in Western Europe, North America, Latin America, and East Africa has been increasing. 1,5–8 Cataract extractions in the second eye represent a sizable proportion of all cataract surgeries performed in developed nations. 1,6,9 This ratio is expected to increase to close to 50% as a result of the bilateral progression of cataracts. 6 Second-eye cataract surgery is regarded as an appro- priate and beneficial procedure to treat visual impairment related to cataracts. 10,A However, the increasing need to improve efficiency and manage con- strained resources has motivated discussions about reducing the volume of cataract extraction and, in turn, rekindled the issue of surgery prioritization. 11 In this context, a 2012 editorial in the British Journal of Ophthalmology 11 presented 3 challenges for eye health professionals, 2 of which are relevant to this review: First, to reach consensus on the best way to demon- strate need and effectiveness; second, to engage in constructive dialogue with health policy makers and managers to ensure appropriate balance between clinical value and constrained resource utilization. Submitted: August 3, 2012. Final revision submitted: January 16, 2013. Accepted: March 9, 2013. From the British Columbia Injury Research and Prevention Unit (Ishikawa, Kerr, Pike), Child and Family Research Institute, British Columbia Children’s Hospital, the Department of Pediatrics (Ishika- wa, Pike, Puri), Department of Emergency Medicine (Desapriya), University of British Columbia, Vancouver General Hospital/Centre for Clinical Epidemiology and Evaluations, and MD Undergraduate Program (Kerr, Hewapathirane), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Dinithi Peiris, PhD, collaborated on this project. Presented in part at the Student Research Forum of the Child and Family Research Centre, Vancouver, Canada, June 2011. Corresponding author: Ediriweera Desapriya, PhD, Department of Emergency Medicine, Faculty of Medicine, University of British Columbia-Vancouver General Hospital, Centre for Clinical Epidemi- ology and Evaluation, 7th Floor, 828 West 10th Avenue, Research Pavilion, Vancouver, BC V5Z 1M9, Canada. E-mail: edesap@mail. ubc.ca. Q 2013 ASCRS and ESCRS Published by Elsevier Inc. 0886-3350/$ - see front matter 1593 http://dx.doi.org/10.1016/j.jcrs.2013.08.033 REVIEW/UPDATE