EWAP MARCH 2024 3 EDITORIAL EyeWorld Asia-Pacific • March 2024 • Vol. 20 No. 1 Graham Barrett Chief Medical Editor EyeWorld Asia-Pacific • China • Korea • India T he Greatest Teacher” evokes thoughts of mentors we have had in our pre- and postgraduate training who have had such a dramatic influence on highlights and careers. Nevertheless, I would suggest the “Greatest Teacher” also applies to our patients and clinical experience over many years. This is particularly the case when discussing considerations for proceeding with cataract surgery. Several experts provide their thoughts and bring to my mind how I counsel my patients, in that the decision to proceed with cataract surgery typically does not rely on the appearance of the cataract or what they read on the chart but rather the difficulty they are experiencing with the clarity of their vision. Once they have reached the stage where the quality of their vision is unsatisfactory for near or distance then proceeding with surgery is advisable as the symptoms will only progress. Naturally, this is accompanied by a discussion on the risks of surgery as well as letting them know that in addition cataract surgery does provide an opportunity to reduce dependence on spectacles. There are of course exceptions. Sometimes, the density or maturity of the cataract is such that deferring surgery may lead to a greater risk of complications. A similar situation arises when there has been recent angle closure, the risk is considered likely, or a previous attack has occurred where removal of the lens is advisable. On the other end of the spectrum, be wary of patients with visual complaints where the density of the cataract does not appear compatible with the symptoms. A recent patient was referred for surgery in his 70s with corrected acuity of 6/6. There was early nuclear sclerosis but his description of visual difficulty was vague and did not match the density of cataract. I performed visual fields and found a bitemporal loss, which was confirmed on MRI to be a pituitary tumor. It is always wise to caution that the prediction of outcome is not 100% accurate despite the best methods of measurement and they will still require reading glasses unless a presbyopic strategy such as extended depth of focus or modest monovision is considered. The old adage of “under-promising and overdelivering” is certainly applicable. Many years after graduating, the decisions we make as ophthalmologists tend to be based on clinical training and the textbooks we have read. With experience however we increasingly consider the patient we have cared for over the years and the lessons we have learned from them—the Greatest Teacher. “
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