THERE IS ALWAYS MORE TO LEARN ABOUT CATARACT SURGERY

BY LEIGH SPIELBERG MD

It can be tempting for experienced surgeons to assume they have nothing left to learn. After all, after thousands of successful procedures, what could possibly be missing? Why spend valuable time buried in the depths of yet another textbook when life—at home and in the clinic—has so much else to offer?

And yet, well-written texts can offer the reading surgeon insight into the knowledge and experience of the surgeon who took the time to distil it into readable form.

It is this distillation that makes books such as Cataract Surgery: Advanced Techniques for Complex and Complicated Cases worth one’s time. Published in Springer’s Essentials in Ophthalmology series—and edited by the Jorge L Alió, H Burkhard Dick, Robert H Osher—this 500-page text approaches cataract surgery with a wide-angle lens while still delving into fine detail. Such is the experience of this trio that it would surprise me if there were anyone who could not learn something from nearly every chapter.

Fortunately, the book does not start with the standard, “Cataract is defined as a clouding of the crystalline lens” introduction. Instead, it opens with a chapter on surgical risk evaluation. The authors encourage a well-organised and highly developed approach.

“When surgeons fail to identify key risk factors in cataract evaluation, it is more likely due to systemic flaws rather than a lack of knowledge or skill in examination,” they observed. “A high level of knowledge about risk factors for complicated cataract surgery is only as good as your system of evaluation.”

This sets the overall tone: a systematic approach emphasising thought and organisation rather than speed and numbers. Considering the volume of patients modern “high-volume” cataract surgeons see, this is easier said than done. It is, however, refreshing to read the high-volume surgeons who authored this text still adhere to the premise extra time taken for in-depth evaluation is not only mandatory but worthwhile for more complex and potentially risky cases.

The chapters in this edition are titled very explicitly, increasing usefulness for those surgeons looking to brush up on a specific topic. Each is dedicated to a specific challenge, like phakic intraocular lens bilensectomy, cataract surgery in the vitrectomised eye, floppy iris syndrome, artificial iris implantation, and MIGS in special cases.

The text itself often introduces a section with a pleasingly direct statement, sharpening the reader’s focus and getting straight to the issue. Regarding phakic intraocular lenses, the authors said, “all pIOLs will be explanted at some point,” implying surgeons will likely face this possibility sooner or later and should prepare.

It’s also sprinkled with fun facts. Who knew, for example, that cataract surgery is performed in 8 per 1,000 population per year in Europe, or the worldwide need for cataract extraction is 56 million per year, while only half of those operations actually occur?

As a vitreoretinal surgeon, I particularly enjoyed the chapter on combined cataract surgery with vitrectomy. It confirmed many of my own conclusions: that combined surgery is generally advantageous, not only for the patient (one procedure required, rather than two), but also for society (it typically results in less time taken off work and allows the patient to resume normal activities more quickly).

I would have liked a more extensive discussion of lens implant options in eyes with no capsular support. Although iris fixation and sutured scleral fixation are tried and tested methods with reasonably good outcomes, they have disadvantages. New, more modern developments, such as sutureless scleral self-anchoring implants, offer the possibility of posterior segment lens implantation without the complex manoeuvres associated with intrascleral fixation, not to mention late-stage lens dislocation.

But this is just a small oversight. The text is otherwise comprehensive, smoothly written, and properly illustrated with slit-lamp and intraoperative photography, decision-making flowcharts, ocular imaging examples, and charts compiling results from the authors’ data or peer-reviewed studies.

Given the scope of the text, who should consider purchasing? This book is suitable for all cataract surgeons, from the resident in training to the phaco fellow, early-career surgeon, and even experienced senior faculty. Whether searching for an introduction to the world of cataract surgery or seeking to update your knowledge and polish your skills, Cataract Surgery: Advanced Techniques for Complex and Complicated Cases might be appropriate for you.