Cataract Surgery Planning in Amblyopic Patients – Which eye first? Awareness of the Potential for Post-operative Diplopia amongst Consultant Ophthalmic Surgeons in Wales

AIM: To explore the views of consultant ophthalmic surgeons in Wales in the context of planning cataract surgery in patients with amblyopia. To compare prevailing views and preferences with recommendations in published literature. METHOD: A cross-sectional survey was conducted in which all consultant ophthalmologists working in Wales were invited to complete an online survey designed using the Survey Monkey tool (http://www.surveymonkey.com). The survey included a clinical scenario involving an amblyopic patient with bilateral cataracts with questions designed to elicit responders’ preferences with regard to which eye they would operate on first as well as the reasoning behind their clinical decision making. RESULTS: 32 out of 42 consultants responded to the survey (a response rate of >75%). With regards to the chronological order of surgery 18 (56.26%) indicated that they would perform cataract surgery first on the non-amblyopic eye, 11 (34.4%) would surgically address the amblyopic eye first and three (9.4%) indicated that patient preference would dictate the choice regarding the laterality of the eye to be operated on first. While 24 responders (75.0%) had encountered amblyopic patients who had developed problems after cataract surgery only 10 (31.3%) opined that formal guidance from the Royal College of Ophthalmologists was warranted. CONCLUSION: These results indicate that awareness of post-cataract surgery diplopia, and in particular fixation switch diplopia, is not widespread amongst consultant ophthalmic surgeons in Wales.