1. Björn Johansson Department of Ophthalmology, Linköping University Hospital Rationale for ISBCS (immediate sequential bilateral cataract surgery) Conflict of interest: Bausch&Lomb, AMO, Zeiss, iSBCS

2. Why? Fast rehabilitation Avoid anisometropia and other binocular disturbances Decrease worry

3. Why? Utilise limited health care resources optimally Lundström et al, Acta Ophthalmol Scand 2009 Decreased costs for society (transports, support staff etc)

4. Research platform Patient serves as control Fast inclusion Effective follow-up Motivated patients

5. Research platform Intraocular lens studies, e. g. Multifocal IOLs Different IOL designs PCO Quality of vision Topical therapy studies, e.g. Comparison between different drugs Effects of preservatives

6. Indications (absolute/relative) Bilateral cataract that is expected to create difficulties if treated with unilateral surgery Expected anisometropia after unlateral surgery Wish for fast rehabilitation Activity level General disease (balance disorder, mobility problems etc) Social situation (living alone, need for assistance etc) Fear of surgery(!)

7. Exclusion criteria (absolute/relative) Patient hesitating Uncertain quality of postoperative care Eye pathology or general disease that increases complication risk Difficult prediction of postoperative refraction Large difference in cataract density between eyes Complication at first surgery

8. Finally, don’t forget… It IS possible to manage with one only…