Take-home message: In the first of a three-part series, Arun C. Gulani, MD, discusses the concept and approach to designing primary cataract surgery.
Editor’s Note: This is the first of a three-part column that will address the concept and approach to designing primary cataract surgery. The two subsequent columns will address staged cataract surgery in complex cases and correcting premium cataract surgery complications.
As in previous columns, I always like to start with the mindset.
Though cataract surgery is considered to be one of the most routinely performed procedure in all of medicine—with millions of cases performed annually—this very concept of a routine surgery is abhorrent.
I believe that cataract surgery is an opportunity for surgeons to enable patients to have the best sight possible for the rest of their life. Because no cataract surgery should be considered routine, each patient deserves not only the best surgery performed using the best technology, but also a designed concept to meet their visual requirements that is tailored to each case individually.
This column is the first of three in which I will share with colleagues the concept and approach to designing primary cataract surgery. The two subsequent columns will address staged cataract surgery in complex cases and correcting premium cataract surgery complications.
In my attempt to always empower colleagues, I would like at the outset also to clarify that beyond a certain necessity, technology is an added benefit, not a crutch upon which to become dependent in the pursuit of perfect vision.
The most important statement I shall make in this column is what I ask my fellows and visiting surgeons when they tell me that a certain patient has a cataract. I follow that statement with my rhetoric: “Cataract and what else”? What I am trying to drive home is a point that whenever we see a patient with a cataract we must ask ourselves “What else?” is associated with it.
This single statement will cause a paradigm shift in our mindset that the industry has spent millions of dollars on in trying to configure premium cataract surgery.
I teach my fellows with an analogy to the game of bowling. First pick all the pins, i.e., associated ammetropia, presbyopia, pathology, etc., and then aim for a strike. To have two pins standing at the end of a throw could be human error, mistake, or complication but to not aim to strike is unacceptable!
This leads us into my four categories of cataract presentations