Blake Williamson, MD, MPH, and Gary Wörtz, MD, invite William Plauché, MD, to review a presentation he recently delivered at the Caribbean Eye Meeting about his experience with PanOptix (Alcon), enVista Envy (Bausch + Lomb), and Tecnis Odyssey (Johnson & Johnson Vision) IOLs. The presentation compared similar amounts of patients and determined nuances between the three different kinds of lenses. Dr. Plauché also shares his experiences and his process for IOL selection.

This year, the theme of our podcast will feature discussions of foundational equipment and emerging technology in ophthalmology. In the first episode of 2025, Roger Zaldivar, MD, MBA, joins Gary Wörtz, MD, to discuss the ICL Guru project and how its complex algorithm integrates with ultrasound biomicroscopy platforms. Dr. Zaldivar shares his experience with ICL surgery, and how he leveraged that expertise to help improve sizing methodology and patient selection.

Rounding out this season’s theme of ‘Surgical Horror Stories,’ Jeffrey Whitsett, MD, joins Blake Williamson, MD, MPH, and Gary Wörtz, MD, to discuss his approach to managing the disappointment of poor surgical outcomes. He also shares a case example in which he encountered a complication during combination MIGS and cataract surgery, which resulted in a significant vitreous hemorrhage.. Drs. Whitsett, Williamson, and Wörtz also review the best ways to navigate potential horror stories in the business side of building a practice.

Gary Wörtz, MD, and Blake Williamson, MD, MPH, invite Nicole Fram, MD, to share a surgical horror story in which a patient experienced light arcs, starbursts, and halos after silicone IOL implantation. Dr. Fram describes her approach to IOL exchange using a Collamer lens with a larger optic to manage the positive dysphotopsias. She reviews the complications she encountered during the procedure, including iris prolapse and iridodialysis, and describes her strategies for managing stressful surgical events.

For the Halloween episode of this season’s surgical horror stories, Cathleen McCabe, MD, joins Gary Wörtz, MD, and Blake Williamson, MD, MPH, to share two uniquely challenging cases. In the first case, Dr. McCabe describes the time she performed cataract surgery on a kyphotic patient who was unable to lie on his back for the procedure. She explains her approach to positioning the patient and how she managed an additional unexpected complication. In the second story, Dr. McCabe discusses a patient with a difficult psychological history.

Sebastian Heersink, MD, joins to contribute to this season’s theme of surgical horror stories. He talks with Blake Williamson, MD, MPH, and Gary Wörtz, MD, about his experience performing cataract surgery on his father and former guest of the podcast, Marnix Heersink, MD. Dr. Sebastian Heersink recounts how he managed the stress of operating on a family member, and how he approached a less-than-perfect result when the lens was slightly decentered on postop day 1, avoiding a potential horror story. He also discusses how he calms unhappy patients by validating their concerns and putting them at ease before surgery.

Arsham Sheybani, MD, joins the podcast to continue this season’s theme of surgical horror stories. He shares a case example with Blake Williamson, MD, MPH, and Gary Wörtz, MD, in which he performed lensectomy in the eye of a 60-year-old woman who presented with angle-closure glaucoma and very high IOP. Following routine phacoemulsification, the anterior chamber began to shallow, eventually resulting in suprachoroidal hemorrhage. Dr. Sheybani also shares advice for communicating with patients about difficult, unfortunate outcomes.

Continuing this season’s theme of surgical horror stories, Neda Shamie, MD, joins Gary Wörtz, MD, to share an experience from early in her career when she faced an unexpected complication. While performing penetrating keratoplasty on a well-known patient, Dr. Shamie encountered an expulsive hemorrhage. She highlights the value of mentorship in these situations and having a trusted colleague to help shape one’s approach to stressful complications during surgery. She also emphasizes the importance of learning from these situations and gaining new surgical skills.

William Trattler, MD, joins Blake Williamson, MD, MPH, and Gary Wörtz, MD, to share a story in which a referring optometrist’s family member presented with dark brunescent cataracts in both eyes. He describes his initial approach and technique for managing these advanced cataracts, including the unexpected complication of a dropped lens and capsular bag tear in the first eye. Weeks after referring the patient to a retina specialist for an eventual good outcome, Dr. Trattler began surgery on the second eye, only to encounter a similar complication.

Paul Walton, MD, continues the discussion with Blake Williamson, MD, MPH, and Gary Wörtz, MD, on approaches to anesthesia and nuances to manage potentially difficult patients during cataract and refractive surgery. Dr. Walton shares pearls to ensure a smooth day in the operating room, mitigating potential ophthalmology ‘horror stories.’