• Macula
• epidemiology
• public health
• retina

For ophthalmologists the question posed in the title is, in colloquial terms, a ‘no brainer’, as there is a wealth of evidence from large well conducted observational studies and clinical trials on the effectiveness of cataract surgery in routine clinical practice, and the specific value of second eye surgery.1–6

With increasingly competitive priorities for interventions making calls on limited healthcare resources, in eye health the spotlight usually falls, in the first instance, on cataract surgery, most probably because of the volume of service activity it accounts for and because a bilateral intervention is often likely. Cataract extraction continues to be the most common elective surgical procedure performed in the National Health Service (NHS). Over 300 000 cataract operations were undertaken in England during 2010–2011, representing about 3% of all elective procedures in the NHS.7 About 30%–40% of all cataract operations are those performed on the second eye.1 8 In response to policy drivers for improving efficiency and constrained resource management, commissioning negotiations for cataract surgery (in the NHS in England) while focusing on effectiveness and interventions of clinical value, have also been directed at reducing the volume of surgery performed and more specifically, …