Glaucoma
September 2023
by Manjool Shah, MD
Glaucoma Editor
One of the pleasures of working in academic medicine is the ability to collaborate at a high level with non-medical colleagues. In a recent conversation about glaucoma surgery I had with colleagues from NYU’s School of Engineering, we found ourselves discussing ways to evaluate, modify, and potentially design safer surgical devices. In a post-meeting wrap-up message, one of the lead engineers told me he was struck by something I said: “The physics only get you so far. The chaos of the human body, the craft of a surgeon’s hand—that’s where medicine lives.”
Surgical successes often need not be explained; we all expect the expected outcome and therefore shouldn’t be surprised when a patient’s surgical course progresses as we thought it would. However, when things don’t quite go the way we intended, we are often at a loss. Understanding the root causes, pathophysiology, and (dare I say) physics of the mechanisms of failure is without a doubt instrumental in not only navigating the murky waters of recovery after complications but preventing unwanted surprises in the first place. Putting this knowledge into the randomness generator that is medicine is where we all get to be artists.
As we all strive to practice better medicine, take the time to dig deeply into your missed opportunities and suboptimal results; it is in these rare events that we push to new heights.
In this issue of EyeWorld, we get into the real challenges of surgical glaucoma. From a discussion of everyone’s Friday evening clinic showstopper, neovascular glaucoma, through complications of MIGS, to a conversation about the dreaded and often mischaracterized malignant glaucoma, our contributors consider first principles in their recommendations for diagnosis, management, and prevention.
My residents and fellows sometimes get sick of hearing me say this, but I’ll subject you all to one of my intraoperative refrains: “Complications are gold—embrace them!” Fortunately, they are rare. As such, treat them as the mines of educational opportunity that they are. As we all strive to practice better medicine, take the time to dig deeply into your missed opportunities and suboptimal results; it is in these rare events that we push to new heights.
