EWAP DECEMBER 2022 3 Vaishali Vasavada, MD Guest Editor EDITORIAL EyeWorld Asia-Pacific • December 2022 • Vol. 18 No. 4 Champions are Brilliant at Basics ----- John Wooden I feel humbled and delighted as I write this editorial for the penultimate issue of 2022. And what better theme than to revisit the basics of cataract and refractive surgery, when one is embarking upon another new year, one filled with hope and promise of better things to come. This issue reminds us that no matter how many sophisticated diagnostics and therapeutics we add to our practice, we can only utilize them best when we know our fundamentals. Unless we understand the physics, mechanics, and optics of every device and technique, it is unlikely that we will truly achieve excellence in our outcomes despite the most modern technology. Cataract surgery has come a long way, and modern phacoemulsification systems are extremely efficient, helping surgeons to enhance their surgical performance. However, both the surgeon and technology will be tested in challenging environments such as dense cataracts, small pupils, floppy irides, and extremes of biometry. Keep in mind that the input and output from the eye need to be balanced, and that keeping a less turbid intraocular environment keeps the uveal tissue flutter at bay and helps maintain a lower intraocular pressure. It is here that technology that allows us to operate using lower parameters, use ultrasound/laser energy more efficiently, and protect from surge will come in handy. A smart surgeon is one who is able to then customize the machine parameters for each scenario, and use the advanced features of technology in trying conditions. Another good example of basics first is the intravitreal injections. With the safety and efficacy of anti-VEGF and steroids, they are now being used extensively, and most often multiple times in each eye. However, what we must carefully watch out for in these patients is short- and long-term intraocular pressure rise. I have personally seen instances of patients reporting no perception of light and even vitreous herniation following intravitreal injections. A simple practice of checking light perception as well as globe pressure at the end of injection would go a long way in protecting the retina and optic nerves in these eyes which often have ocular or systemic comorbidities. Corneal refractive surgery and presbyopia correcting IOL technology is evolving at a fast pace, and we now have many more options that allow us to confidently deliver both quantity and quality of vision. Yet missing out subtle ocular surface problems in refractive cataract surgery often lands surgeons in trouble with nagging, unhappy patients and a bad name for the IOL technology. Using newer imaging for corneal irregularities, wavefront analytics, and ocular surface disease, one can now not only diagnose but even predict the visual performance to a large extent. And yet, one must remember that every new technology needs to be tested and validated in a particular patient demography. To be used widely, the technology must be scientifically robust and also have ease of operation apart from being pocket friendly! All in all, every feature of this issue, be it on corneal astigmatism, the ever-elusive angle alpha (and its many interpretations!!), the good old trabeculectomy and the surprisingly insightful data from the clinical registry at a large healthcare setup is worth your time. I also think it is time we all start focusing our research and innovation on the amount of biowaste we generate and sooner than later re-evaluate some of the practices that could be more wasteful than useful. Any small change that can have a positive environmental impact is the dire need of the day, and of the times to come. I wish you all a Very Happy Year End and a Happier, More Fruitful Year to Come. Let us all pledge to keep thinking about every small aspect that we often perform mechanically in our daily lives. Let us continue striving for something better, something newer, something that carries forward the legacy left to us by our predecessors.
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