Are our cataract surgical outcomes as good as they can get? If the answer is that there is still room for improvement, then how?

The outcome of cataract surgery is determined by the patient, the technique, and the surgeon: the patient where there is coexisting morbidity; modern techniques (most notably the implantation of an intraocular lens and probably small incision methods) have transformed the quality of visual rehabilitation; and—dare we say—the “better” the surgeon the “better” the results. There is often little we can do to influence co-morbidity. As for technique, we have countless papers, posters, presentations, and videos promoting new techniques claiming excellent results (but rarely of sufficient study design quality to justify the claims). But what of the surgeon? Can the surgeon improve and if so how?

Habib et al’s paper in this issue of BJO (p 643) describes the association between higher volume and lower complication rates which has been noted in other spheres of surgery but not so far in ophthalmology. The message is—the more you do, the fewer the complications. This is just an association, and one cannot tell from this kind of study which way the cause and effect works. It could be that “better” surgeons do more …