Gosh, golly; That day in the summer of 1996 was clear as day. For me, it was a Friday night lights moment, and I was legit about to assist with my first cataract surgery. This day was dope: I had just had a free muffin in the doctor’s lounge and changed out of my acid-washed denim jacket and into some bogus scrubs that fit mostly like draped cardboard. Whatever, I couldn’t care less because I was mesmerized by the rad surgery that I was about to witness. Many surgeons were still doing extracapsular cataract surgery, lame. But not in this case, this surgeon was sick. She was totally leading-edge, using phacoemulsification with only a 3.5 -mm incision, so small that it often required only 1 stitch instead of 3. The foldable intraocular lens magically opened unharmed inside the eye, a novel breakthrough that was just becoming popular. In fact, this surgeon kept it real: she performed only 15 vitrectomies a year, compared with many who performed 25 or more. In this case, the patient also had glaucoma and was on the only available treatment: theoretically compliant with pilocarpine 4 times a day, timolol twice a day, and oral diamox. We were stoked to combine this surgery with a trabeculectomy with mitomycin C. As I sat down next to my attending, the stage was set: Springsteen on the radio, my beeper handed off to the circulating nurse, and, as I prepped the eye, I was prepped to reference the newest Seinfeld episode I had recorded on my VHS just the night before. Gee whiz, I recall the authenticity of what I was about to witness as the Honig cuff was applied to the eye to dissipate the retrobulbar block. Well, I’ll be, this was like watching a space shuttle landing: advanced technology and impossible to imagine surgery could get any better for patients or surgeons. Jeepers, was I wrong. But wrong in a good way.
Ophthalmology Management (OM) and I began our journey together 30 years ago. Seems impossible that time went so fast, but what is more impossible is how significantly our field has changed in such a short time. Despite both feeling that we are at our core the same over time, it must be that the world around us has changed. Oh man, we are both wrong. But wrong in a good way.
Ch-ch-changes. The evolution of our profession is not directly the result of our focus on inventing, adapting, and implementing innovation. Instead, it is a direct result of our motivation to provide best-in-class care for our patients: When work aligns with meaning and purpose, we find ways to change enough to safely fail at times yet continue to pave the way forward. As we reimagine what we can be, our focus on caring for patients helps us maintain resilience throughout our 30-year journey. Some days are like our first day at work, when we implant our first MIGS device, load a novel presbyopic lens, or put on 3D glasses to perform cataract surgery while watching a 60-inch television. Some days are not so good, like when using a newer OVD and the handle breaks off, allowing the cannula to rip the peripheral retina during cataract surgery (patient did well after repair of retinal tear), or meeting with over 100 patients to explain that the glaucoma device in their eye is working great but has been recalled, and we need to “observe” closely. However, most days seem routine and not very memorable, leaving us wondering how we have come so far.
How does time lapse? This day-to-day time lapse is similar to the operating room, where the case can only lapse quickly when the surgeon is fast between steps, rather than trying to be fast during each step of the surgery. Yes, the world around us changed, but we evolved too. We have updated values, fresh perspectives, and new abilities that prepare us for the changes in the world around us. The material of the lenses I use in cataract surgery is only 4 years old, the femtosecond laser in cataract surgery is only 11 years old, and the MIGS devices I use are 8 years young. In fact, last week I looked around my operating room between cases and realized the only thing there that had been there 15 years ago was me.
Let’s unpack this 30-year anniversary without trying to rizz up OM. Present-day ophthalmic surgery is already low-key impossible to imagine with all the optimize out and low-friction tech. I would be anxious but function if we warped back in time and I had to do surgery in 1996. The scrubs were cringe, the surgical videos from that era live rent-free. Big yikes. I went to the stand-up desk in my office in my post-COVID clinic uniform—athleisure scrubs—and wondered what this could look like 30 years from now. It is impossible to imagine surgery could get any better for patients or surgeons. Oof, anything I say about the future is prob cap. But cap in a good way.
Happy 30th anniversary, OM. Thirty years from now, I suspect the slang won’t be words at all … just emojis. 🚀🤖😂
Author's note: ChatGPT or other AI was not used to assist with this article. However, my 4 kids (age 20-28) helped edit the final 2 paragraphs.
