Surgeons speculate about future of ophthalmic surgery

In the future, will ophthalmic surgeries be easier to perform than they are now? Intuitively, one might expect the answer to be an obvious “yes,” and superficially, some of the recent upgrades in our surgical equipment appear to confirm this impression. But surprisingly, ophthalmology’s historical trend appears to be in the opposite direction: In general, eye surgeries may be becoming more difficult.Consider, for example, cataract surgery. Initially, the operation consisted entirely of couching the lens into the back of the eye. Intracapsular extraction was the major successor, which was a superior solution but significantly more technically demanding. Next came the extracapsular techniques, which were more demanding still, eventually yielding to the panoply of modern phacoemulsification tactics available today, with their substantial logistical and strategic considerations, concerning, for example, lens type, power, material and position. And although many “simplifying” innovations have indeed been introduced, including the use of trypan blue, iris retractors and upgraded phacoemulsification technologies, for the most part, these steady refinements have been swamped by periodic revolutions, which have increased the complexity of cataract surgery overall (Figure 1).