Cynthia L Larche¹, Alejandro Oliver^1,2, Runjie B Shi^3,4, Steve A Arshinoff^5,6*

¹Northern Ontario School of Medicine University, 935 Ramsey Lake Rd, Sudbury, ON P3E 2C6, Canada
²Timmins and District Hospital, 700 Ross Ave E, Timmins, ON P4N 8P2, Canada
³Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada
⁴Temerity Faculty of Medicine, University of Toronto, Toronto, ON M5S 3K3, Canada 5Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON M5S 3K3, Canada
York Finch Eye Associates, 2115 Finch Ave W #316, Toronto M3N 2V6, Canada

*Corresponding Author: Steve A Arshinoff, Department of Ophthalmology and vision Sciences, University of Toronto, Toronto, ON M5S 3K3, Canada.

Received: February 27, 2026; Published: August 03, 2026

Abstract

Objective: To evaluate whether changing the calculated intraocular lens (IOL) power for the second eye, based on the refractive outcome of the first eye, in delayed sequential bilateral cataract surgery (DSBCS), enhanced refractive results in a single surgeon’s practice.

Design: Retrospective comparative-effectiveness study.

Participants: Patients undergoing DSBCS with monofocal IOLs, whose first-eye IOL was targeted for close to plano based on optical biometry, at a regional ophthalmology center in Northern Ontario. Exclusion criteria included cases with any other IOLs or power determination by intraoperative aberrometry.

Methods: Cases performed between January 2022, and December 2023 were reviewed. Statistical analyses were performed using Microsoft Excel and SciPy.

Main Outcome Measures: Age, sex, interval between surgeries, and refractive outcomes for each eye were evaluated. Success of second-eye IOL adjustment was determined by comparing the predicted spherical equivalent error (SEE) in the second eye with the predicted outcome based on biometry-suggested IOL. 

Results: 116 of 688 DSBCS cases were included after exclusions. No significant difference in SEE (p = 0.13) was observed between 35 cases with second-eye IOL modifications (mean SEE ± standard deviation = 0.57 ± 0.47 diopters) and 81 unmodified IOL cases (0.43 ± 0.38 diopters). Among the IOL-modified cases, the mean difference between chosen lens and biometry-suggested lens SEEs was 0.0343D (p = 0.61; 95% CI: -0.0994D to +0.1680D), confirming equivalence between groups.

Conclusions: Interprocedural IOL adjustments in DSBCS in this single surgeon’s practice did not enhance refractive outcomes. These results align with broader studies suggesting no refractive advantage for DSBCS over ISBCS.

Keywords: Immediately Sequential Bilateral Cataract Surgery; Delayed Sequential Bilateral Cataract Surgery; Intraocular Lens; Refractive Outcomes; Refractive Surprise; Intraocular Lens Power; Quality Improvement

Abbreviations: ISBCS: Immediately Sequential Bilateral Cataract Surgery; DSBCS: Delayed Sequential Bilateral Cataract Surgery; IOL: Intraocular Lens; REB: Research Ethics Boards; SEE: Spherical Equivalent Error.

References

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Citation

Citation: Steve A Arshinoff., et al.“Impact of Interprocedural Intraocular Lens Selection Changes on Refractive Outcomes in Delayed Sequential Bilateral Cataract Surgery: A Retrospective Study of a Single Surgeon’s Practice Precipitating Conversion to Immediately Sequential Bilateral Cataract Surgery in Northern Ontario, Canada". Acta Scientific Ophthalmology 9:1 (2026): 09-13.

Copyright

Copyright: © 2026 Steve A Arshinoff., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.