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EW CATARACT 47 March 2016 what we learned in training is not necessarily completely satisfactory, but there is the hazard of missing out on a better method. • Clustering bias. When mishaps or challenges occur during surgery, especially when they occur in clusters, we tend to question our methods and even our very skills, grasping at straws, trying new things that may or may not be superior or are in fact worse in our hands. • Argumentum ad populum. Every- one's doing it, so it must be better. • Fallacy of novelty. If it's new, it must be better. • Appeal to fear. If you don't adopt new methods, you risk being left behind. I hope this will provide food for thought for those who are consid- ering other methods, validation for those who continue to use certain methods after trying others and see- ing no reason to change, and to help us overcome our biases. EW Editors' note: Dr. Gossman is in private clinical practice at Eye Surgeons & Physicians, St. Cloud, Minn. He has no financial interests related to this article. Contact information Gossman: n1149x@gmail.com Steven Safran, MD, Lawrence- ville, N.J., thinks that horizontal chop has the advantage of safety: "Horizontal chop can be done in a very controlled manner supporting the nucleus as you do it so there's minimal or no stress on the zonules. It can be done in the bag away from the endothelium with low phaco energy using a mechanical crossing motion." Two out of 3 surgeons use a different method depending on cataract density. There is a trend toward preferring one of the "carou- sel" methods for softer cataracts, a chop method for medium cataracts, and divide and conquer for dense cataracts. My own methods are carousel for soft cataracts, stop and chop for medium cataracts, and divide and conquer for dense cataracts. Why do we use the method we do? No doubt it relates to what works best for our own dexterity, neurologic makeup, and personality, but some of it may be due to bias. • Status quo bias. We human beings tend to stick with what we learn and accept change reluc- tantly when problems occur, new methods come along that seem irresistible, or evidence of superi- ority becomes irrefutable. As the saying goes, "If it isn't broken, don't fix it." This is not to say that The totals may not equal 100% due to rounding. The fifth question was, "Please explain why you use the method you do for average density cases." There were 60 responses and are discussed below. The sixth question was, "Please explain why you use a different technique for different density cataracts, if this is the case." There were 44 responses and are discussed below. As you can see, as with other parts of cataract surgery, there is great diversity in what methods are employed to divide the nucleus for phacoemulsification, and surgeons no doubt achieve excellent results or they would explore other methods. Jay Erie, MD, Mayo Clinic, Rochester, Minn., prefers divide and conquer for most cases: "The biggest advantage to me is that most of the phaco energy is expended in the bag; therefore, it is 'free' phaco power with respect to potential endothelial trauma." Ravi Krishnan, MD, Eye Institute of Corpus Christi, Texas, prefers the carousel method with its virtue of speed and applicability to cataracts of any density. "I use the phaco handpiece in quadrant removal mode to begin chewing at the nucleus from its equator, causing it to spin into the port." " Why do we use the method we do? No doubt it relates to what works best for our own dexterity, neurologic makeup, and personality, but some of it may be due to bias. " –Mitchell Gossman, MD View the EyeWorld CME and non-CME supplements at: cmesupplements. eyeworld.org supplements. eyeworld.org

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