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UPFRONT: Just Because You Can, Should You?

As I sit here in a brand-new Boeing 737-900, flying across the country, I am reminded of the common saying, “Just because you can do something does not mean you should do something.” Because while this new airplane has cool LED overhead lights that change colors to fit the time of day or mood of the flight attendants, it also requires a flight attendant to pull out the antiquated safety demonstration equipment and actually perform the skit in the aisles while another reads the safety briefing over the PA system — no prerecorded announcement or funny safety videos. I have not seen such an old-school safety demo in years, but the flight attendants have to do it because the plane has the world’s worst airline seats, designed with the goal of fitting in one more row of passengers, with no video monitor, no storage space, and no cushioning whatsoever. This is definitely a case of smaller, thinner, and lighter being worse, not better.

So, is this the case with microincision surgery? While there is no question that the speed, efficiency, faster recovery, and lack of sutures of microincision surgery are appealing, do we need to go smaller, thinner, and lighter than our current offerings? What is the sweet spot for microincision surgery? For me it currently is 23 gauge because the forceps I use is not made in a smaller gauge, so I have no reason to go smaller in macular cases or PVR. For diabetes, however, a smaller gauge better establishes tissue planes and speeds the case. But, the lack of all instruments, slower vitrectomy speeds, and instrument flexibility are still issues. Some companies are talking about going even smaller. Just because you can, does not mean you should.

Similarly, in this issue we discuss 3D heads-up surgical displays. Is this also a case of doing something just because we can? Older versions had considerable latency, non-HD displays, and other issues. Newer systems have largely solved those issues, but is this really better for patient care, surgical efficiency, or safety? There is no question that having the entire surgical team viewing the same massive display is cool, but does the stereopsis and depth of field improve or detract from the surgery? When intraoperative, real-time OCT, instrument tracking, image overlay, and possibly even a digital microscope are integrated, the answer may be unequivocally yes. Finally, should we always operate just because we can? There are many situations where not operating may be better for the patient. We explore these ideas in this issue.

For airlines, their focus is the bottom line: filling their airplanes with as many people paying the highest amount their algorithmic pricing strategy will allow, with upcharges for seats, baggage, boarding privilege, and even food. It is a shame the romance of travel is gone and passengers are now cattle. But for retina specialists, at the end of the day, it is all about improving patient care, outcomes, and safety.