Contrary to our observations Suh

Contrary to our observations, Suh et al. found that part-time occlusion therapy resulted in a significant p97 of the deviating angles at distance. However the data for near deviation in the Suh et al. study concur with our results. Similarly, 27% of patients in the Freeman and Isenberg study became orthophoric and 45.5% had an asymptomatic exophoria at the last examination which differs from our deviation angle results at distance. Furthermore, Iacobucci and Henderson showed a beneficial effect of occlusion therapy on exodeviations, both in pattern type and size of deviation which also disagrees with our results for deviation at distance. In addition, Spoor and Hiles reported an improvement in 54% in the deviation angle at distance and concluded that occlusion therapy decreases the size of the deviation. However, Berg, Lozano and Isenberg found that occlusion therapy decreases deviation angle at near (77%) and distance (56%). Newman and Mazow found that 87% of their subjects who were treated with occlusion therapy reported decrease in the deviation size or converted to phoria which differs from our findings.
Few studies concur with some of our results but not all our results. Other studies however used different methodology than ours and compared occlusion therapy to other treatment modalities. Cooper and Leyman found that occlusion therapy is useful in breaking down suppression with 63% of the cohort who were treated with occlusion therapy showing fair to good results for deviation angle, stereopsis and fusional amplitudes which partially agrees with our results in the stereopsis and fusional amplitudes part only. Chutter found that the size of the deviation decreased after treatment application which differs from our findings but the fusional ranges were improved and the fusional recovery (control) was strengthened which is similar to our findings.
We aimed at the end of our research to answer the following questions:


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Simultaneous bilateral cataract surgery, now more accurately referred to as immediately sequential bilateral cataract surgery (ISBCS) – to clearly differentiate it from delayed sequential bilateral cataract surgery [DSBCS], is still a controversial topic in the ophthalmic world and has to come a long way to become a routine procedure. There have been many positive studies on this subject, and every year surgeons convinced of the benefits of this method join together for discussions and lectures while also attending the meetings of the European Society of Cataract & Refractive Surgeons (ESCRS). Still, the method has as many opponents as supporters.



One of the earliest scientific reports of simultaneous binocular cataract in one operating session comes from 1952. Initially this applied to ICCE operations. Over the years, surgical techniques were refined and supporters of ISBCS appeared. ISBCS began to become common with the advent of small incision Phaco, although there are some places that do it with manual small incision cataract surgery (MSICS) now as well.
In Poland, even though there are a few surgeons who operate simultaneously both eyes, there are few documented cases of such operations. In the identified publications, we discovered that in the period from January to December 1985, 48 operations by cryoextraction were performed, and from March to June 1999 3 treatments of ISBCS were performed, all due to the health of the patients requiring surgery under general anesthesia. The operation of each eye was treated as a separate procedure, and all were run under strict aseptic conditions. In none of these cases there were early or late postoperative period complications observed.
In 2009, 10% of responding members of the ESCRS were performing ISBCS. The leading country for the proportion of ISBCS done is Finland. Routine ISBCS has been common there since 1996, and many hospitals currently perform ISBCS on 40% to 60% of cataract patients. Spain’s region of the Canary Islands perform 80% of all cataract surgeries in this way with explicit government approval, which recently concluded that “ISBCS, as a surgical alternative for cataract patients, is as safe and effective as conventional DSBCS”. In the Canadian province of Ontario, ISBCS has increased from 1.02% of total cataract surgeries in 2003/2004 to 2.36% in 2009/2010, with a 40% increase in total provincial cataract surgical volume over the same period. Thus, there has been a consistent increase in the performance of ISBCS in Ontario, over the 7years from 2003 to 2010, a pattern similar to what is currently seen worldwide. Australia was similar to Canada in that it practices a fee-for-service reimbursement with simultaneous second-eye discounts of 50%. In contrast to report on ESCRS member activities, the American Academy of Ophthalmology does not endorse simultaneous procedures due to potential serious complications, such as endophthalmitis and poorer refractive outcomes, that are considered to be associated with the technique. As such, DSBCS remains the standard of care in the United States, and ophthalmologists face financial penalties for performing ISBCS. In Israel and Japan, ophthalmologists receive no reimbursement for the second simultaneous bilateral cataract surgery. In the United Kingdom, ophthalmologists received 80% of the first-eye fee for the second eye in simultaneous bilateral cataract surgery from some insurance providers, but more often only 40%.