A good story has an arc: tension and resolution. Without tension, there is no ultimate sense of accomplishment. Without resolution, there is only stress.

Many surgeons have such an arc built into their weekly rhythm. The surgery day is one of intense focus in which we impact our patients’ vision, a sense that they hold most dearly. Later, after a successful surgery, we celebrate the results together.

For me, the end of a surgery day has a much greater sense of accomplishment than the clinic days. In fact, I write this having just finished a surgical day, proud of what our team has done for our patients and preparing to coach some little league baseball and then relax this evening.

For many ophthalmologists, the clinic and administrative time we spend serves only as support for those crucial hours in surgery. No matter which day of the week is the OR day, that is likely the most intense time of the weekly arc.

In this issue on IOLs and surgical instrumentation, articles focus on various aspects of those crucial hours in the OR.

THE STATE OF IOLS AND LENS-BASED SURGERY

What do surgeons need to know about the new classes of presbyopia-correcting and adjustable IOLs? Diffractive multifocals make patients very happy, as do modern extended-depth-of-focus lenses. What do we make of the new classes of IOLs — adjustable IOLs, pinhole optics and non-concentric multifocals?

The articles in this issue will not address the new category of monofocal-plus lenses, which are classified as monofocals but have extended focal areas. While monofocal plus lenses can add value for some patients, I have found it much easier to generate excellent patient happiness with those same platforms’ EDOF and multifocal lenses and let monofocals be monofocals. I also philosophically think it’s wiser to respect the divide between presbyopia-mitigating IOLs and monofocals, as the innovations that have come out of the presbyopia IOL space have generated some of the most enjoyable post-op patient celebrations of my career.

The traditional OR experience was distinct from refractive surgery decades ago, but now the two are inextricably linked. This issue addresses the growth of lens-based refractive surgery, since we are now far beyond the overly simplistic “refractive surgery = LASIK” equation. The OR is now a major site of refractive surgery, whether with refractive lens exchange or ICL.

ON TECHNOLOGY AND TECHNIQUES

Are we in a movement from traditional microscopes to 3D heads-up surgery, in an ergonomic revolution that will add years to surgeons’ careers and protect us from neck injuries? We may be able to use 3D heads-up surgery as a tool to learn new techniques from colleagues as the surgical innovation curve becomes more vertical.

In fact, what are the best practices for learning techniques while in practice? Long gone are the days (if they ever truly existed) in which ophthalmologists continued the same residency-learned techniques for a whole career.

Also, what are the best ways to prioritize safety and sterility now that we as a field are learning how much waste the OR environment produces? What aspects of sustainability in the OR does industry value that we surgeons don’t consider? These are all topics addressed in this issue.

I’m thankful for the invitation to be guest editor of this issue, in which our contributing writers address many important topics for those most crucial hours of our week — our time in the OR. OM

O. BENNETT WALTON IV, MD, MBA, is a cataract, refractive and cornea surgeon. In addition to clinical practice, he is a surgeon for clinical trials and evaluation of new refractive and cataract technologies. Dr. Walton was named to Ophthalmology Management’s 40 Under 40 list in 2022 and is a founding member of the Oracle Vision Council. Disclosures: Dr. Walton revealed relationships with AbbVie/Allergan, Alcon, Avedro, Bausch + Lomb, Beaver-Visitec International, Bruder Healthcare Company, LensAR, RxSight, Staar Surgical, Tarsus Pharmaceuticals and Carl Zeiss Meditec.