EWAP JUNE 2023 3 EDITORIAL EyeWorld Asia-Pacific • June 2023 • Vol. 19 No. 2 Graham Barrett Chief Medical Editor EyeWorld Asia-Pacific • China • Korea • India Nexus describes connection and was a very apt theme for the recent APACRS meeting in Singapore. Those of you who were able to attend will agree that this was one of our most successful APACRS meetings, particularly after the virtual meetings, which kept us going during the COVID experience. Of particular interest was the session on “What they don’t teach you during Residency” where we canvassed such topics as how to create an award-winning video, better presentations, and even considering life balance issues. Meanwhile, the APACRS Lim Lecture this year was delivered by Gerd Auffarth who provided a comprehensive survey of refinement in lens optical design and new materials. The meeting confirmed how important our annual meeting is in maintaining personal contact and sharing information on new technologies and techniques which is the core of the APACRS philosophy. In addition to the summary of our annual meeting in Singapore, this month’s issue of EyeWorld Asia-Pacific also contains many topics of interest. I was particularly drawn to the articles on managing patient expectations and dealing with unhappy patients after cataract surgery. The core issue evident in the relevant articles is the importance of ensuring patient expectations are managed appropriately. The long- standing adage of “under promise and over deliver” is true for cataract and implant surgeons. The use of multifocal IOLs promises spectacle freedom but with the occasional patient who is disappointed either in the quality of vision or unwanted optical phenomena. When using this technology, it is important to have personnel with some expertise or access to the treatment of minor residual refractive errors which have more impact in this context. One of the reasons for the increased interest in extended depth of focus IOLs is preserving better quality vision while still providing practical solutions to patients requiring intermediate and even near vision. The focus on total spectacle independence may not be the most important criteria to patients’ satisfaction. A related article reminds us how invariably a patient’s perception of their second eye surgery differs from their first eye experience. They are more aware of the second eye surgery and the “wow factor” may be less. I have found that second eye comparison is less of an issue with modest monovision as they anticipate the second eye will be different reducing the unavoidable comparison inherent when both eyes are targeted for distance. I hope you find the highlighted articles as well as the other topics covering corneal disease, endothelium transplantation, and glaucoma of interest. Connecting everyone and everything, also the key theme of the recently concluded APACRS annual meeting, cannot be more relevant in today’s times. On one hand, we are progressing rapidly in our science, in our practice. But as we look to the future, it is also important that we bridge it with the past. Phacoemulsification is currently the gold standard procedure for most cataract surgeons. However, as we evolve, automation in cataract surgery will be more and more prevalent. While they do make our job as surgeons easier, possibly more precise, there is and always will be a role for manual techniques. Therefore, it is important for today’s trainers to equip our residents and fellows with skills such as suturing, vitrectomy, and creating scleral flaps and tunnels. Again, technology will be the connecting link. The free and widespread availability of videos, tutorials, and simulators should be encouraged more and more, even if hands-on training cannot be imparted in every situation. Another such scenario is the increasing popularity of DMEK over DSEK. As is discussed in this issue, tissue handling is different with both procedures, and although they may both one day be obsolete with artificial corneas and cultured endothelial cells, we need to prepare our corneal surgeons to be adept in them. Complicated situations such as re-grafts and eyes with comorbidities may still need conventional penetrating keratoplasties or DSEKs. It is up to us trainers to identify the necessary skills that still need to be taught. We also need to really connect with our patients and their perceptions, as in the piece on how patients perceive their second eye cataract surgery. Many of us have noticed more patients complaining of pain, discomfort, or just a general feeling of “last time was different!” It is up to us to spend time counseling patients about these phenomena prior to their second eye surgery. There is an interesting feature on the relation between patient personality and perceived outcomes following presbyopia-correcting IOL surgery. It seems that here, too, there is a connection between the sex and personality traits and how happy or otherwise patients will be. Connection also means recognizing that we as ophthalmologists have been afforded a true privilege of being able to positively impact lives. Connecting our patients with good vision, good eye health, and ultimately better lives is something we must never underestimate. We must continue to strive for better, taking the good things from our past while embracing the future with open minds. Abhay Vasavada Trending in Ophthalmology Deputy Regional Editor EyeWorld Asia-Pacific
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