Our guest surgeon from Japan does a great job for this routine cataract case which is number 450. Reaching case 500 (or close to it) represents a critical inflection point in the cataract surgery learning curve, often described as the transition from technical competence to intuitive mastery. At this stage, a surgeon has typically moved past the initial “survival phase,” where the primary focus is on completing the capsulorhexis and nuclear emulsification without major complications like posterior capsule rupture. Having performed several hundred cases, the surgeon’s motor skills are becoming reflexive, allowing cognitive bandwidth to shift toward more nuanced aspects of the procedure. Case 500 is considered the halfway mark by me because while these surgeons can reliably handle routine cases, they are now entering the phase of managing complications and challenges such as moderate zonular instability. This milestone bridges the gap between basic proficiency and the advanced ability to handle high-risk pathologies or unexpected vitreous loss with composure. It is the point where surgical efficiency increases, and the focus shifts from simply finishing the case to optimizing refractive outcomes and doing the best surgery possible.
