Eyeworld

SPRING 2026 | EYEWORLD | 59 C Contact Micheletti: morgan.micheletti@gmail.com Patel: ppat27@gmail.com Relevant disclosures Micheletti: Alcon, Bausch + Lomb, Diamatrix, Glaukos, Iantrek, Johnson & Johnson Vision, MicroSurgical Technolo- gy, New World Medical, Nova Eye Medical, Zeiss Patel: None Phaco machines and platforms Different phaco machines can offer different features during surgery. "The various phaco platforms certainly differ in characteristics such as fluidics, chamber stability, energy delivery, efficiency, and ergonomics," Dr. Patel said. "The differences are based on which pump system[s] are integrated into the platform. Once the principles of these are understood, transitioning among machines is usually straightforward." She added that familiarity with multiple plat- forms is helpful, but adaptability and under- standing how the machine behaves in different surgical scenarios is more important than mem- orizing specific settings. Dr. Micheletti compared the different phaco machines to golf clubs. A good golfer should be able to play well with different sets, even though each performs slightly differently. "How- ever, each golfer may perform better with a spe- cific set of clubs (machine) tailored specifically to them (proper settings)," he said. MIGS procedures and devices Another important area of training is MIGS, particularly with an increase in combined MIGS and cataract procedures. "A relatively large percentage of the general patients we see in clinic have glaucoma," Dr. Micheletti said. "In my experience, that trans- lates to roughly 10–20% of cataract patients with glaucoma. As such, comfort with angle anatomy should now be considered a core skill for all surgeons as we should, at a minimum, be managing glaucoma alongside cataract surgery." He thinks that angle surgery/MIGS, procedural pharmaceuticals, and interventional glaucoma should be compulsory for every modern eye surgeon in training. "I do think it is important to have familiarity with MIGS coming out of residency," Dr. Patel said. "While not every anterior segment surgeon will commonly perform MIGS as part of their practice, I think at the very least, knowledge of these procedures is essential for appropriate patient counseling and referral. Furthermore, do- ing MIGS solidifies your understanding of angle anatomy to a level that every ophthalmologist should know." She noted that many residency programs include MIGS exposure now, though the extent can vary. "I think an easy place to start is doing a combined cataract procedure with either a goniotomy or a stent, and once you're comfortable with working in the angle and using a gonioscopy lens intraoperatively, then you can move on to more involved procedures." Additional areas of training Beyond IOL and phaco platforms, Dr. Patel noted that understanding advanced diagnostics and imaging is increasingly critical. "Technolo- gies such as OCT and OCT angiography, corneal tomography, modern biometry, and data-driven outcomes tracking should play a major role in current ophthalmology training," she said. "However, in my opinion, the most important skill physicians can develop is the ability to crit- ically evaluate, adopt, and appropriately apply new technologies as they emerge." She added that integrating AI into ophthal- mology clinical practice may be something that will be more commonplace in the future. "As far as non-clinical things that physicians should be trained on, I think billing and coding and professional advocacy are two areas that more programs could focus on." Boris Malyugin, MD, PhD, EyeWorld Refractive Editorial Board member, shared what he is looking forward to at the 2026 ASCRS Annual Meeting: "I am planning to attend the 2026 ASCRS Annual Meeting in Washington, D.C., because it represents a unique opportunity to immerse myself in one of the most comprehensive professional gatherings dedicated to anterior segment surgery. I anticipate expanding my clinical knowledge, refining surgical techniques, and staying current with emerging evidence and technologies. I am particularly interested in attending the International Intra-Ocular Implant Club symposium, which focuses on complex cases and complication management."

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