Simplicity. It’s a concept that’s often overlooked when we’re surrounded by new technology and techniques. But when I treat patients, I always ask myself, "What’s the simplest, most effective way to help this person with the least risk?" Simplicity inspired me to be the first to limit my practice to the use of lens implants in 1974 – to do one thing and do it well. It was the simple notion of taking care of my patients, not building a practice, that was, and is, my focal point.

Here, I’ll explain how this idea of simplicity has served my patients and me so well. If I can pass on a thought or two that may help you in practice, all the better.

I have long approached cataract surgery as an opportunity to correct refractive error. Cataract surgery shouldn’t just be a rehabilitative procedure to restore best corrected vision. It’s a chance to provide patients with the best vision of their lives. Improving a patient’s quality of vision means a better quality of life.

Refractive cataract surgery requires strict attention to detail and going the extra mile. My patients receive many additional services that are not reimbursable – simply because it’s the right thing to do. Value-added services increase the safety and predictability of surgery. Here are some other examples:

• Filtering the irrigating solutions
. I’ve long been an advocate of filtering the irrigating solutions. I believe it saved my practice years ago when I received a contaminated batch of saline solution. Colleagues who’d the same contaminated solution had several cases of endophthalmitis. I had none.
• Intraocular antibiotics.
There will always be arguments against intraocular antibiotics because of the concern over resistance. But if we inject antibiotics into a sterile container, it’s theoretically impossible to develop resistance to organisms outside the community. I believe using intraocular antibiotics saves eyes and that the possibility of resistance is more theoretical than real.
• Polishing the capsule
. I meticulously polish the posterior and anterior capsule to reduce the need for a capsulotomy later on. The benefits of this simple technique are worth the minimal effort.
• Piggyback lenses
. If you’re committed to refractive cataract surgery, you must provide extremely high hyperopes and myopes with piggyback lenses, when indicated. Certainly, these cases can be more challenging, but it’s so rewarding to minimize a patient’s dependency on glasses. You should also be comfortable with secondary piggybacks and lens exchanges (when the primary lens can be easily removed) if you miss the target refraction.
• Limbal relaxing incisions.
This is the finishing touch for a satisfied patient. If you’re truly dedicated to pleasing your patients, you should be willing to correct as little as 0.75 diopter of astigmatism. I rely on manual keratometry, topography and surgical keratometry for the most accurate results.
• Checking the intraocular pressure (IOP) in the early postoperative period.
This is absolutely essential to minimize the risk of infection. Surprisingly, I know of very few surgeons who have incorporated this approach into their practices. I check the pressure early because I want to know that the wound is water-tight. Of course, it’s equally important to know that you have no IOP spike. If either condition exists, it must be addressed immediately – before the patient goes home.
• Ultraviolet (UV) lighting.
When the OR is not in use, UV lights are activated to reduce the risk of bacteria. These are also used in cardiology units.
• Ultrasound and intraocular lens (IOL) calculations
. My ultrasound staff uses the immersion method and the Holladay II IOL Consultant software. Measurements are checked and rechecked to ensure accuracy.

Refractive cataract surgery requires dedication and willingness to go the extra mile. Sometimes that means rethinking techniques that have served us well for years, and getting out of our "comfort zones." I believe in exceeding standards of care through value-added services, because my patients deserve the safest possible procedure and the best attainable quality of vision. It all goes right back to where it started. Simplicity. The simplicity of placing the patient first.

How our author has succeeded

Dr. Gills, a leading lecturer and innovator in ophthalmology, started his practice in a small building in Tarpon Springs, Fla. in 1968.

-Sean McKinney, Editorial Director