EyeWorld Asia-Pacific September 2013 Issue

3 EWAP September 2013 Letter from the Editor Dear Friends T his month’s issue of EyeWorld Asia-Pacific is focused on Cataract Challenges. A common thread that runs through the comments of all contributors to the management of challenging cataract cases is the need to be prepared. It is so important not only to be aware of surgical techniques and maneuvers that may help one manage a difficult situation but also to have the many helpful pharmacological agents and devices that make a key difference in these situations. Non-preserved phenylephrine can be of assistance with cases with floppy iris syndrome and retentive viscoelastics can make all the difference in protecting the endothelium with extremely dense cataracts. Similarly, the availability of iris hooks and the Malyugin ring can be essential in performing phacoemulsification safely with a small pupil. Being prepared means having appropriate back-up lenses available, as a three-piece lens or even a sutured IOL may be required to manage situations such as a partially subluxated lens due to trauma. Similarly, the availability of a vitreoretinal surgeon may be appropriate when managing cases with combined anterior segment and posterior segment pathology. This can offer assurance that the entire procedure can be completed as a single procedure rather than separate ones. Finally, in extremely complex cases, the anesthesia should be appropriately selected, including general anesthesia in some circumstances. The other facet of cataract challenges that we all encounter is deciding which new technology or device is appropriate for our practice. Due to the complex interweaving of commercial influences on therapeutic advances in ophthalmology, it is often difficult to discern what truly is of value as opposed to fashion or fad with profit rather than improved outcome as the major driving force. I think we all appreciate that without the drive for commercial success advances would simply not occur, but we should all examine each concept critically to ensure that our patients’ safety and interests remain primary in considering new techniques and technology. I hope you enjoy the content of this issue on Cataract Challenges, which contains many helpful insights in managing difficult cases and also addresses some of the challenges in selecting which new technologies will be helpful in improving one’s own practice. Warmest regards Graham Barrett, MD Chief Medical Editor EyeWorld Asia-Pacific EYEWORLD ASIA-PACIFIC EDITORIAL BOARD C HIEF MEDICAL EDITOR Graham BARRETT, Australia MEMBERS Abhay VASAVADA, India ANG Chong Lye, Singapore CHAN Wing Kwong, Singapore CHEE Soon Phaik, Singapore Choun-Ki JOO, Korea Hiroko BISSEN-MIYAJIMA, Japan ASIA-PACIFIC CHINA EDITION Editors-in-Chief ZHAO Jialiang ZHAO Kan Xing Deputy Editor HE Shouzhi Assistant Editor ZHOU Qi ASIA-PACIFIC INDIA EDITION Regional Managing Editor S. NATARAJAN ASIA-PACIFIC KOREA EDITION Regional Editor-in-Chief Hungwon TCHAH Regional Managing Editor Chul Young CHOI Hungwon TCHAH, Korea John CHANG, Hong Kong Johan HUTAURUK, Indonesia Kimiya SHIMIZU, Japan Pannet PANGPUTHIPONG, Thailand Prin ROJANAPONGPUN, Thailand Ronald YEOH, Singapore S. NATARAJAN, India YAO Ke, China Y.C. LEE, Malaysia