EWAP SEPTEMBER 2023 3 EDITORIAL EyeWorld Asia-Pacific • September 2023 • Vol. 19 No. 3 Graham Barrett Chief Medical Editor EyeWorld Asia-Pacific • China • Korea • India M aking Practice Perfect” touches on many aspects of the various areas of anterior segment surgery. "Making Practice Perfect for Post-refractive cataract patients" emphasizes the importance of paying attention to every detail of patient care when performing cataract surgery. This is important in both straightforward and challenging cases including patients who have had previous refractive surgery and keratoconus. This attention to detail is what distinguishes a merely competent surgeon from one who consistently achieves excellent outcomes. In striving for perfection, we are assisted by improvements in technology as highlighted in the article recalling the introduction of YAG laser capsulotomy which revolutionized the management of posterior capsular opacification. Similarly, the selection of lenses in patients who have had previous refractive surgery is less uncertain with the availability of instruments that are able to measure the posterior cornea and improved formulae. I think we all would acknowledge how the creation of flaps during LASIK has improved with the availability of femtosecond lasers and the introduction of MIGS has offered new opportunities for patients with glaucoma. All procedures require surgical skill but one of the major changes that has occurred over the years is the important role of surgical planning and IOL selection. Where before this often consisted of simply circling a lens on a biometer printout, today it requires considered thought, multiple devices, and an understanding of the specific formulae required depending on the context. I have been fortunate to have supervised many fellows over my career and one question that I have often been asked is what distinguishes a surgeon regarded as excellent from one of average ability. My answer is that surgical expertise is essential but a continued focus on striving for perfection in all aspects of care plays an equally important role. This issue is a timely reminder of the key role that this philosophy plays in providing personal satisfaction as well as better outcomes for our patients. I hope you find the articles interesting and helpful in your own practice. T hroughout this issue, surgeons discuss how we “Make Practice Perfect,” improving upon the techniques and technology of the past such that issues that were challenging then are much simpler to manage now. IOL exchange, once intimidating with unpredictable outcomes, is now much more predictable. We now have a better understanding of how we can minimize damage to the corneal endothelium and the posterior capsule, use better instruments, smaller incisions, and so can promise patients better outcomes. However, this refinement only comes through a meticulous process of sharing and analyzing without bias, publishing all results, even the problems. Often, we become biased towards a particular idea and then consciously or subconsciously try to justify it. But in order to perfect a technique, it is crucial that surgeons from different parts of the world evaluate it in their respective patient sets; an approach that works very well in one place may not work as well in another. In the ESCRS clinical survey trends from 2016 to 2021 presented in this issue, the authors point out that the percentage of glaucoma surgical/MIGS procedures actually decreased, with fewer cataract surgeons performing them in 2021 compared to 2019. Such data should make us think about why these differences in trends occur. While there may be several reasons—accessibility, resources, government funding policies, availability, training—one must carefully evaluate mid- and long-term results. Having unbiased datasets from different parts of the world and sharing experiences across platforms will be the way forward. A large part of achieving perfection is understanding the current limitations of a particular innovation and then rectifying them. In the end, those innovations that are reproducible and widely applicable in different parts of the world are the ones that will stand the test of time. Abhay Vasavada Trending in Ophthalmology Deputy Regional Editor EyeWorld Asia-Pacific “
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