Eyeworld

40 | EYEWORLD | FALL 2026 ATARACT C by Kendall Donaldson, MD, MS Cataract Editor Refinement also means learning from ex- perience. As Jennifer Lindsey, MD, reminds us, even sophisticated technologies such as femto- second laser-assisted cataract surgery require an appreciation of their unique nuances. Recogniz- ing uncommon complications before they occur reflects the maturation of both technology and surgical judgment. Likewise, Amar Alwitry, MD, highlights how something as seemingly routine as securing a cannula deserves renewed atten- tion. Sometimes the most meaningful advances in patient safety come not from new devices but from recognizing overlooked opportunities to improve familiar steps. The same philosophy extends to our oper- ating rooms themselves. Combined phacovit- rectomy platforms are not simply about adding another feature to a surgical machine. They represent a broader trend toward integrating technologies that improve efficiency without compromising quality. As cataract and retina care increasingly intersect, our equipment is evolving to support multidisciplinary care while helping surgeons manage complex situations more seamlessly. Anthony Mai, MD, Michael Patterson, DO, and Christina Y. Weng, MD, MBA, share their perspectives on this topic. When I think back to residency, I don't remember anyone talking about refractive cataract surgery, digital image guidance, or sustained drug delivery. We were simply trying to master the fundamentals of cataract surgery. Those lessons remain the foundation of every- thing we do today. The difference is that today's surgeons have extraordinary tools that allow us to perform those same fundamentals with great- er precision, predictability, and efficiency. We honor the past not by practicing exactly as we once did, but by remembering the prin- ciples that brought us here. We refresh our per- spective by embracing new ideas with curiosity rather than skepticism. And we refine our care through thousands of small improvements that, together, transform the patient experience. If we were to recreate that residency pho- tograph today, much around us would look dif- ferent. But the surgeon behind the microscope strives for exactly the same goal: giving every patient the best vision possible through the very best surgical experience. Progress through continuous refinement E very ophthalmol- ogist has a photo- graph tucked away somewhere—a residency picture with oversized loupes, an early operating microscope, or perhaps a younger version of ourselves standing proudly after completing one of our first cataract cases. The hairstyles may be questionable, and the technol- ogy certainly looks dated, but one thing remains remarkably familiar: our commitment to helping patients see better. Looking back reminds us just how much our field has changed. Yet perhaps the more remark- able realization is that the greatest advances have not always come from revolutionary breakthroughs. More often, progress has been achieved through continuous refinement—tak- ing good ideas and making them safer, more efficient, and more patient centered. That spirit is reflected throughout this issue of EyeWorld. Today's cataract surgery is nearly unrecog- nizable compared to what many of us learned during training. But despite remarkable advanc- es, the principles we learned as residents remain unchanged: meticulous surgical technique, respect for ocular tissues, anticipation of compli- cations, and thoughtful decision-making. What has evolved is how we apply those principles. The discussion surrounding dropless cata- ract surgery is an excellent example. The goal has never changed—to prevent infection and inflammation while providing patients with the safest possible recovery. What has changed is our ability to accomplish that goal in ways that reduce treatment burden while improving convenience for both patients and practices. As intracameral antibiotics and sustained drug delivery strategies continue to gain acceptance, the conversation has shifted from whether we can eliminate postoperative drops to determin- ing which patients are the best candidates and how to implement these approaches safely and effectively. Innovation here is not about replac- ing established care but thoughtfully refining it. Read what John D. Bartlett, MD, Scott LaBorwit, MD, and Marissa Larochelle, MD, have to say about dropless cataract surgery in 2026. Dr. Donaldson as a medical student in 1997 Source: Kendall Donaldson, MD, MS

• Cover