We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

Simultaneous Cataract Surgery for Bilateral Congenital Cataracts Are the Cost Savings Worth the Risk?

Burton J. Kushner, MD
Arch Ophthalmol. 2010;128(8):1073-1074. doi:10.1001/archophthalmol.2010.148.
Text Size: A A A
Published online


Speaking about foreign policy in his 1961 inaugural address, John Kennedy said, “ . . . we shall pay any price, bear any burden, meet any hardship . . . to assure the survival of liberty.” A similar ethos was reflected in national attitudes toward medical care in that era, and the words “cost-benefit ratio” were barely part of our lexicon. If a treatment or intervention was felt to be of benefit, the relative cost was scarcely considered. Now, almost 50 years later, we have learned that we must pay more attention to how we use precious and limited resources, both with respect to foreign policy and dispensing health care. Thus, it is not surprising that Dave and coauthors1 addressed the relative cost of simultaneous vs sequential bilateral cataract surgery for infants with congenital cataracts in this issue of the Archives. In this relatively small series, they attempted to assess comparative visual outcomes, adverse events, and economic costs of 10 children who underwent sequential surgery with 17 children who underwent simultaneous surgery for treating bilateral congenital cataracts. Not surprisingly, they found no cases of endophthalmitis and no difference in other serious surgical complications in either group. Given the low incidence of endophthalmitis after pediatric cataract surgery, one would not expect such a small sample size to detect any difference in that regard. Perhaps somewhat surprisingly, they found no visual benefit with simultaneous surgery. One of the major reasons that some have advocated simultaneous surgery is the theoretical better visual outcome that might occur in the eye operated on second because of its earlier visual rehabilitation. The only quantifiable benefit they found with simultaneous surgery was economic; they found a 21.9% reduction in cost with simultaneous surgery. This raises the philosophical and ethical question “Should this cost saving play an important role in our decision about the timing of surgery for bilateral congenital cataracts?” It would be lamentable, in my opinion, if cost alone drove the answer to this question. Any proper cost-benefit analysis needs to include comparative benefits and risks. What is troubling to me about the study by Dave et al is that although they compared adverse outcomes in these 2 small groups of patients, they did not adequately discuss comparative potential risks—2 very different issues. A comparison of potential risks must be an essential part of the discussion.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

3 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles