There is an old saying, “a good workman never blames his tools,” and that holds true for ophthalmic surgery. An ophthalmologist’s hands are the most valuable instruments in surgery. Remember that the machinery and instrumentation that we use can make us better, but they cannot make up for deficient hands. Many surgeons across the globe are using phaco machines and microscopes that are at least a decade old, if not older. Yet these surgeons still do beautiful surgery to restore vision to their patients. These surgeons know that it is not the instruments that make us good but how we use these instruments. If there is a complication in surgery, it is rarely the fault of the instruments or machines but more likely the manner in which they were used.

Upgrading to the latest technological advances in equipment can assist us in producing even better outcomes, with lower risks and faster visual recovery. In Los Angeles, our surgery center in Beverly Hills has every conceivable piece of equipment, the latest in high-tech devices, and new technology that is simply amazing. For patients who have surgery in this facility, congratulations, because it is the best of the best.  However, the costs are higher there. To purchase millions of dollars of equipment, the surgical revenue must be sufficient to justify the costs

In another area in Los Angeles, I have operated in a surgery center where the microscope and phaco machines are much older and do not have any of the newer advancements. This center has a microscope that was made in West Germany, which ceased to exist in 1990. This microscope is about 30 years old, but it is sufficient for me to still do a beautiful cataract surgery for these patients. The difference in cost compared with the latest microscopes is tremendous, with the newer models costing about 30 times as much.

When I was a young child, I thought that the newest athletic shoes would make me a faster runner, but it turns out that was not the case. Now, when I teach my ophthalmology residents, I try to remind them that the limitation for surgical success is primarily their hands and not just the equipment. This is particularly true early in the learning curve of surgery but still rings true even in the hands of very experienced surgeons.

Maximize your access to the best devices, instruments, and platforms, but remember that at the end of the day, the most critical factor is the surgeon’s hands and judgment.




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