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Aims-To analyse the clinical and sociodemographic characteristics associated with second eye cataract surgery. Methods-An observational, longitudinal study of patients scheduled for first eye cataract surgery that did not involve a combined procedure was carried at two teaching hospitals and one non-teaching hospital in Barcelona, Spain. Patients were followed for 2 years after first eye cataract surgery to assess whether and when they had undergone second eye cataract surgery. Clinical characteristics, perceived health characteristics (perceived visual function and overall health status), and sociodemographic characteristics were compared between two patient groups-those with surgery in only one eye and those who had undergone surgery in both eyes by the end of the 2 year follow up period. Results-Of the 242 patients studied, 125 (51.7%) underwent second eye surgery during the 2 year observation period. Patients with visual acuity 6/18 (0.3) or worse in the second eye compared with those with visual acuity over 6/12 (0.5) and patients younger than 65 years compared with patients aged 65-74 were more likely to undergo second eye surgery (adjusted odds ratio 3.9 and 1.8, respectively). 52 (44.5%) patients in the only one eye surgery group had a visual acuity less than 6/18 (0.3) in the second eye. Conclusions-Worse visual acuity in the second eye and younger ages are strongly associated with both eyes cataract surgery. There may be a potential increase of demand for this procedure in the near future since almost half of the patients with only one eye surgery presented a low visual acuity in the second eye. (Br J Ophthalmol 2000;84:9-12) Cataract surgery is the most frequent surgical procedure performed among the elderly in the developed countries, and it has undergone an important increase in recent years.1 2 It is estimated that in the USA, 3 4 UK, 5 6 and Sweden 7 only one third of patients who have had first eye surgery subsequently undergo second eye surgery during the following 12 months. But available studies show an improvement in visual function and in stereoacuity after second eye surgery and suggest that better outcomes be achieved if patients undergo surgery in both eyes. 4 8-13 Debate over the need for second eye surgery is influenced by the growing demand for cataract surgery, at times accompanied by long waiting lists. The significant cost associated with the possible generalisation of second eye surgery has led some medical insurance companies and national health services to give higher priority to first eye surgery than to that of the second eye. 4 7 14The Agency for Health Care Policy and Research 15 and other authors 16 have concluded that surgery in the second eye should be recommended, specifically among patients who need good binocular vision. Some authors also have suggested that the decision to operate on the second eye is influenced by the patient's perceived need of surgery, and by social expectations. 17 But there are no studies assessing specifically the decision related t...

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