By the mid 1990s, the evolution of progressively safe and predictable cataract surgery saw the resurgence of centuries of interest in performing immediately sequential bilateral cataract surgery (ISBCS). Within 10 years ISBCS had become generally accepted and the International Society of Bilateral Cataract Surgeons (iSBCS) was formed (September 2008) to “promote education, mutual cooperation, and progress in simultaneous bilateral cataract surgery.” The first initiative of the society members was to create a document “iSBCS General Principles for Excellence in ISBCS 2009,” which was intended to disseminate information about the best practices they had discovered to assist novice ISBCS surgeons. Next, ISBCS needed to be studied. Soon, data began to clarify some advantages of ISBCS, and risks were carefully evaluated. It soon became apparent that the main impediment to the performance of ISBCS, globally, was money, in that many jurisdictions financially penalized surgeons who performed ISBCS. Presently, we know that ISBCS carries many benefits to the patient, his/her family, the surgical facility, and society. The feared risks for simultaneous bilateral endophthalmitis, the requirement to adjust intraocular lens (IOL) selection for second eyes, based on first eye results, and others, have simply not been borne out under scrutiny. ISBCS is now rapidly increasing in its performance and acceptance globally, but the financial factors remain to be solved.