Article Text

A stakeholder meeting exploring the ethical perspectives of immediately sequential bilateral cataract surgery
  1. Matthew Quinn1,
  2. Daniel Gray2,
  3. Ahmed Shalaby Bardan3,
  4. Mehran Zarei-Ghanavati4,
  5. John Sparrow5,
  6. Christopher Liu3,6,7
  1. 1Royal United Hospital Bath NHS Trust, Bath and North East Somerset, Bath, UK
  2. 2School of Social Sciences, Cardiff University, Cardiff, UK
  3. 3Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, UK
  4. 4Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, The Islamic Republic of Iran
  5. 5Bristol Eye Hospital, University Hospitals Bristol NHS Trust, Bristol, Somerset, UK
  6. 6Brighton and Sussex Medical School, Brighton, United Kingdom
  7. 7Tongdean Eye Clinic, Hove, United Kingdom
  1. Correspondence to Professor Christopher Liu, Sussex Eye Hospital, Brighton BN2 5BF, UK; cscliu{at}


Purpose The purported benefits and risks of immediately sequential bilateral cataract surgery (ISBCS) have been well described, yet the procedure remains controversial among UK ophthalmologists. As many of the controversies of ISBCS are underpinned by ethical dilemmas, the aim of this work was to explore the ethical perspectives of ISBCS from a variety of stakeholder viewpoints.

Method A semi-structured independent stakeholder meeting was convened at the Royal College of Ophthalmologists London headquarters in June 2018. In total, 29 stakeholders attended the meeting. The professional characteristics of stakeholders included but were not limited to: ophthalmologists (9), patients (5), religious leaders (4), ethicists (2), lawyers (2) and commissioners (1). Thematic qualitative analysis using methodology proposed by Braun and Clarke was conducted on the resultant transcript of the discussion.

Results Themes identified include: (1) beneficence and non-maleficence (patient benefits, patient risks, the uncertainties of risk, patient interpretation of the risk-benefit analysis); (2) autonomy (informed consent, the barriers to communication); (3) distributive justice (the allocation of resources: the individual vs the collective).

Conclusion This analysis provides a reference point for the ethical factors surrounding ISBCS. The stakeholders concluded that this approach was an ethical undertaking provided patient autonomy was appropriately attained. This requires a patient’s interpretation of the risk-benefit balance, which must include an understanding of the low but unquantifiable risk of severe complications. A surgeon must aim to minimise risks through the adaption of accepted surgical protocols and by performing appropriate patient selection. Currently, cost savings to healthcare that may occur following the implementation of ISBCS should be considered a secondary benefit of the protocol.

  • informed consent
  • surgery
  • autonomy
  • ethics
  • patient perspective

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  • Correction notice This paper has been updated since first published to amend author name 'Mehran Zarei-Ghanavati'.

  • Contributors MQ transcribed the meeting, performed qualitative analysis and took the lead in writing the manuscript. DG performed independent qualitative analysis. CL and JS devised the project, organised the stakeholder meeting and invited participants. JS attained funding for the project. CL and ASB wrote and reviewed the stakeholder questions, both participated in the stakeholder meeting. MZG provided specific ethical advice for input to the manuscript. Additionally, all authors provided significant contribution to the written work, rewriting sections where required with regular amendments to drafts. All authors approved the final version of the work.

  • Funding This study is funded by the National Institute for Health Research (NIHR) Programme for Applied Research grant RP-PG-0611-20013. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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