Short answer: yes. Cataract surgery on both eyes on the same day is safe, and studies find results similar to having the eyes done on separate days. In Australia, the limit is funding. If you have private health insurance, most funds won’t pay the hospital for the second eye on the same day, so insured patients usually have their eyes done on separate days. If you’re uninsured, both eyes can be done on the same day, with a 50% lower Medicare rebate for the second eye. For refractive lens exchange, both eyes on the same day is routine.
| Your situation | Both eyes on the same day? | Why |
|---|---|---|
| Private health insurance | Usually not; eyes done on separate days | Most funds won’t pay the hospital for the second eye on the same day |
| No health insurance | Yes, if your eyes are suitable | Medicare rebate for the second eye is halved, so it costs slightly more, but it’s one trip and one recovery |
| Refractive lens exchange | Yes, usually | Medicare and health funds don’t apply |
Can you have cataract surgery on both eyes at the same time?
Yes, as two separate operations, one straight after the other. This is called immediately sequential bilateral cataract surgery (ISBCS). Having them on different days is delayed sequential surgery.
What the evidence shows:
- A 2022 Cochrane review of 14 studies covering more than 276,000 people found probably no clinically important differences in outcomes between same-day and separate-day surgery, and lower costs with same-day surgery. The risk of serious eye infection (endophthalmitis) was very low in both groups, with no evidence of a higher risk with same-day surgery, and accuracy of the final prescription was similar (Dickman et al., 2022).
- In the US IRIS Registry, infection rates were 0.059% of eyes after same-day surgery and 0.056% after separate-day surgery, a difference that wasn’t significant (Lacy et al., 2022).
- In a survey of 95,606 same-day operations by members of the International Society of Bilateral Cataract Surgeons, no patient had an infection in both eyes. The four cases of infection in both eyes reported over 60 years all involved breaches of sterile protocol (Arshinoff & Bastianelli, 2011).
How we keep two eyes completely separate
When we operate on both eyes on the same day, we treat them as two totally separate procedures:
- The theatre is set up again from scratch for the second eye, with new instruments, drapes and equipment.
- Injections and medications for each eye come from separate batches, with different batch numbers.
- The second eye is prepared, cleaned and draped as if it were a new patient’s operation.
Those precautions matter: the rare reported cases of infection in both eyes after same-day surgery all involved breaks in sterile technique (Arshinoff & Bastianelli, 2011).
At Focus Vision, you’re fast asleep for cataract surgery, with deep sedation from a specialist anaesthetist through an IV line, numbing drops and no needles around the eye. With same-day surgery, that’s one hospital visit for both eyes. See can I be asleep for cataract surgery?
Why health insurance makes same-day surgery difficult in Australia
The barrier is funding, not safety. When both eyes are done on the same day, most private health funds won’t pay the hospital for the consumables and equipment used for the second eye. Doing the second eye properly means a complete second set-up, so the hospital carries that cost itself, which makes same-day surgery financially unviable for insured patients. A review of same-day surgery worldwide noted the same problem: it is cost-effective for patients and payers, but reimbursement models in many countries create significant financial barriers for hospitals and surgeons (Singh et al., 2017).
So if you’re having cataract surgery through your health fund, expect your eyes to be done on separate days. See cataract surgery cost for what your fund and Medicare pay.
Without health insurance: same day, with a smaller Medicare rebate
If you’re not insured and you’re paying the hospital yourself, both eyes can be done on the same day.
Medicare still contributes to your surgeon’s and anaesthetist’s fees for cataract surgery (MBS item 42702). But under Medicare’s Multiple Operation Rule, when two operations are performed on the same occasion, the benefit is based on 100% of the schedule fee for the first and 50% for the second (MBS note TN.8.2). In other words, the Medicare rebate for the second eye is halved.
That makes same-day surgery cost slightly more, but many patients and their families find the trade worthwhile:
- One hospital visit, one fasting morning and one anaesthetic
- One lift to and from hospital for family or carers
- One recovery, and clear vision in both eyes sooner
- No weeks of imbalance between a treated and an untreated eye
Cataract surgery at Focus Vision costs $2,500 to $5,500 per eye, depending on your insurance and lens; see our costs page and cataract surgery cost guide.
Refractive lens exchange: both eyes on the same day
Refractive lens exchange (RLE) is the same operation as cataract surgery, done to reduce your need for glasses before a cataract has formed. Because Medicare and private health insurance don’t cover RLE, the funding rules don’t apply, and both eyes can usually be done on the same day as two separate procedures. RLE at Focus Vision is $6,000 per eye, including the anaesthetist. See refractive lens exchange cost and refractive lens exchange.
Same day or separate days: pros and cons
| Same day | Separate days | |
|---|---|---|
| Hospital visits | One | Two |
| Recovery | One recovery period | Two, with a gap in between |
| Vision in between | No imbalance between eyes | Weeks of one treated and one untreated eye |
| Fine-tuning the second lens | Not possible | First eye’s result can guide the second |
| Health fund | Most funds won’t pay the hospital for the second eye | Covered as usual |
| Medicare (uninsured) | Second eye rebate halved | Full rebate for each eye |
Who is better off having the eyes done on separate days?
Same-day surgery isn’t for everyone. Appropriate patient selection matters, and one recognised drawback is that the surgeon can’t use the first eye’s result to fine-tune the lens for the second (Singh et al., 2017). Your surgeon may recommend separate days if:
- Your lens calculations are less predictable, for example after previous laser eye surgery (see cataract surgery after LASIK or PRK)
- You have other eye conditions that make surgery more complex, such as Fuchs’ dystrophy or a previous corneal transplant, where your surgeon wants to see how the first eye recovers
- You’re trying a different focus in each eye, such as monovision, and want to see how the first eye feels
- You’d simply prefer to have one eye done at a time
How long between cataract surgery on each eye?
If your eyes are done on separate days, the second eye is usually done anywhere from the next day to seven days after the first. A longer gap is rare. We may wait longer if you’ve had a corneal transplant and we want the first eye to recover fully, or if you have Fuchs’ dystrophy, a condition of the inner layer of the cornea, and we want to see how the first eye recovers before operating on the second. Your surgeon will advise on timing for your eyes.
How will I see between operations?
Between the two operations, your treated eye and untreated eye may focus very differently, which can feel unbalanced. Options include having the lens taken out of your glasses on the treated side, wearing a contact lens in the untreated eye, or simply managing for the short gap. Check with us before driving: you need to meet the driving standard with both eyes open.
Should both eyes see the same afterwards?
Usually both eyes are set for clear distance vision, and you use reading glasses for close work. Some people choose to set one eye slightly for near; see monovision vs blended vision. With a premium lens, both eyes are usually set to work together.
Talk to us about your options
At your assessment, tell us whether you have private health insurance and whether same-day surgery matters to you. We’ll explain whether it suits your eyes and what it means for your costs before you book.
Call (07) 3239 5005, email hello@focusvision.com.au or book online. For more about the operation itself, see cataract surgery and how long cataract surgery takes.
References
- Dickman MM, Spekreijse LS, Winkens B, et al. Immediate sequential bilateral surgery versus delayed sequential bilateral surgery for cataracts. Cochrane Database Syst Rev. 2022;4(4):CD013270. pubmed.ncbi.nlm.nih.gov/35467755
- Lacy M, Kung TH, Owen JP, et al. Endophthalmitis rate in immediately sequential versus delayed sequential bilateral cataract surgery within the IRIS Registry data. Ophthalmology. 2022;129(2):129-138. pmc.ncbi.nlm.nih.gov/articles/PMC8755857
- Arshinoff SA, Bastianelli PA. Incidence of postoperative endophthalmitis after immediate sequential bilateral cataract surgery. J Cataract Refract Surg. 2011;37(12):2105-2114. pubmed.ncbi.nlm.nih.gov/22108106
- Singh R, Dohlman TH, Sun G. Immediately sequential bilateral cataract surgery: advantages and disadvantages. Curr Opin Ophthalmol. 2017;28(1):81-86. pubmed.ncbi.nlm.nih.gov/27684294
- Australian Government. MBS Online, item 42702 (lens extraction and insertion of intraocular lens). health.gov.au
- Australian Government. MBS Online, note TN.8.2: Multiple Operation Rule. health.gov.au