From Complication to Innovation

Kendall E. Donaldson, MD, MS

Cataract and Refractive Surgery Today

We ophthalmologists strive for precision and predictability. Advances in imaging, diagnostics, and surgical technology have elevated the standard of care to remarkable levels. Cataract and refractive surgery now routinely deliver outcomes that would have seemed extraordinary only a few decades ago. Despite these advances, complications remain an inevitable part of surgical practice. No amount of experience or technology can eliminate them. What matters most is how we respond. A complication in the OR can disrupt a carefully constructed plan, but it can also become a moment when preparation, judgment, and creativity intersect. Difficult situations often yield the most valuable lessons. When we remain calm, reassess the situation, and consider alternative strategies, we may still achieve a successful outcome. Preparation is essential.

The First Win Is On The Surface

Cathleen M. McCabe, MD

Cataract and Refractive Surgery Today

Key Takeaways Ocular surface disease management belongs at the start of cataract and refractive surgical planning because tear film instability makes preoperative measurements unreliable, reduces refractive accuracy, degrades postoperative visual quality, and compromises patient satisfaction. Stable ocular surface data support a sound surgical plan from the outset. Patients with ocular surface disease often lack classic dry eye symptoms and instead attribute blur, glare, fluctuating vision, irritation, or reduced visual quality to cataract, a cloudy capsule, or an imperfect surgical result. Early tangible improvement builds trust in the diagnosis and strengthens treatment adherence. Long-term, multifaceted ocular surface disease management gains traction when patients experience an early win in comfort or visual quality, a milestone that supports reliable measurements before surgery and reassures dissatisfied patients after surgery. Newer therapies and treatment strategies make these early wins more achievable. Guidance on ocular surface disease (OSD) management is plentiful. Cataract and refractive surgeons understand how tear film instability can affect preoperative measurements, the refractive accuracy of surgical intervention, patients’ postoperative quality of vision, and, ultimately, their satisfaction. We also know how common OSD is in our patient population. For many of us, however, the ocular surface remains a secondary consideration—something to address after measurements are taken, the IOL is chosen, or a patient returns dissatisfied.

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