Removing OVD from behind the IOL

Surgeons in training often ask, “Do I need to remove the viscoelastic from behind the IOL at the end of … More

Complete Cataract Case: a very special case

This is a complete cataract case, shown from the making of the first incision to the sealing of the incision. … More

The Subtleties of Cataract Surgery

The difference between good cataract surgery and great cataract surgery comes down to subtleties. There are very slight nuances to … More

Complete Case: Cortical Cataract

With a cortical cataract, patients are very symptomatic, particularly if the cortical opacities are within the visual axis. These tend … More

Review: Optimizing Cycle Time Efficiency

Establishing a consistent routine in the operating room is the key for both increased efficiency as well as increased safety. … More

Show me a beautiful cataract surgery

Here on CataractCoach.com we have hundreds of teaching videos, and many of them are of very complex or complicated cases … More

Benchmark: Senior Resident Chop

This is a good benchmark for what a senior resident should be able to achieve by the end of residency … More

Complete Case: Soft Cortical Cataract

Another addition to our series on Complete Cataract Cases is this technique for soft cortical cataracts. These cataracts are typically … More

Cataract Quiz: Where should you make the incision?

Our phaco incisions will induce an astigmatic change in the cornea and we can use that to help achieve a … More

Complete Case: Cataract in a Small Eye

Looking at this picture, we can see that the corneal diameter is very small compared to the size of the … More

The Chopper Push Technique

Watch this video carefully and you will see that the chopper instrument is used just once to create a single … More

Complete Case: Chop in the Bag

Again we have a complete case, from start to finish, showing a routine cataract surgery with a phaco chop technique. … More

Review: Optimizing Cycle Time Efficiency

Establishing a consistent routine in the operating room is the key for both increased efficiency as well as increased safety. … More

How much force for hydro-dissection?

When we perform hydro-dissection, how much force is needed? What volume of balanced salt solution is required? What are the … More

Refining your Surgical Signature

It is so important for surgeons to take pride in their work. You must do a great job, or don’t … More

Setting Up for Cataract Surgery

Cataract surgery is team work and the surgeon is just one member of the team. We need a great team … More

Epi-Nucleus Flip Technique

With a thick epi-nuclear shell, it is easier to remove it with the phaco probe as compared to the I/A … More

Review: External View of Cataract Surgery Steps

Two of the most critical steps in cataract surgery are the main phaco incision and the capsulorhexis. Properly completing these … More

Review: Side View of Hand Position

While we do hold the phaco probe with a pencil grip, we do not use the same angle as writing with … More

Checking the IOP at the end of surgery

We want to ensure an appropriate intra-ocular pressure (IOP) at the end of surgery. This puts the eye in a … More

Struggling with Phaco Chop? Let me help you

I will be the first to tell you that mastering phaco chop is not easy, but it is certainly worth … More

The trick to bring cataract pieces to the phaco tip

This is one of my favorite tricks to teach residents: when there is a nuclear piece of cataract in the … More

It takes new surgeons years to figure this out

This is such a great lesson, that I’m going to limit the text here. Watch the video and learn something … More

Tear Out of the Anterior Capsule

In this video, which was anonymously submitted, an experienced surgeon encounters a routine cataract case where the anterior capsule is … More

Cataract Surgery Lessons from Kyoto

I recently went to Kyoto, Japan for ophthalmology business development projects and I also had a chance to visit a … More

Draping the Eye for Cataract Surgery

Draping the eye is important for cataract surgery. It helps us to create a sterile field and it isolates the … More

Mastering Divide-and-Conquer Phaco

Back by popular demand! Most beginning surgeons start by learning divide-and-conquer as the primary method of nucleus division for cataract … More

Review: Achieving the State of “Flow”

The psychological state of Flow is described as “energized focus, full involvement, and enjoyment” of the action being performed. Some call this … More

Left-Handed Phaco: What is different?

In this video we review the differences between right-handed phaco and left-handed phaco. As expected, the instruments are held differently, … More

Expert Level Divide-and-Conquer

Many surgeons like the divide-and-conquer technique and it is widely used here in the USA. For young surgeons, it is … More

How to sculpt a nuclear groove

Sculpting a groove in the nucleus is required for techniques such as divide-and-conquer and stop-and-chop. The groove works best when … More

Guest Surgeon: Phaco Chop Technique

This video was anonymously submitted by an experienced surgeon who wants us to analyze the phaco chop technique and give … More

Resident Stop and Chop Cataract #50

After doing 50 cataract surgeries, most beginning surgeons have developed good technique for the steps of the procedure. For surgeons … More

Review: Angle sweep to remove all OVD

When we fill the eye with viscoelastic, we push it with the greatest force into the opposite angle of the … More

Cataract Surgery Draping is Critical

Watching amazing intra-ocular acrobatics during a challenging cataract case is exciting and makes for a great video, but those cases … More

Surgeon Ergonomics for Ocular Surgery

As an ophthalmic surgeon, you will spend a large part of your future in the operating room performing delicate ocular … More

Analysis of a Divide-and-Conquer Cataract Case

This anonymously submitted video is from a surgeon who is 5 years into practice after the culmination of her training. … More

Review: Embed the phaco probe without ultrasound

The classic teaching for phaco chop and quadrant removal is to embed the phaco probe into the nuclear piece by … More

What is the correct way to hold a fluid syringe?

When we have a syringe that is filled with liquid, be it balanced salt solution or visco-elastic, we have a … More

Does Capsule Polishing prevent capsular opacity?

There has been much debate around the issue of polishing of the undersurface of the anterior capsular rim, yet there … More

Guest Surgeon Efficient Divide-and-Conquer

After thousands of cases, surgeons become very efficient and can complete cataract procedures with fewer instruments and less surgical trauma. … More

Review: Cataract Surgery in Patients age 90+

Average life expectancy is at an all-time high in the US at 79, with even better news for people who … More

Quiz: For a pupil like this, what is your approach?

With time, young ophthalmologists develop surgical judgment and they are able to look at a case and decide what approach … More

Cataract Surgery using a Scleral Tunnel Incision

Twenty years ago, when I did my residency training at the Jules Stein Eye Institute at the UCLA School of … More

Phaco Flip & Chop is great for Beverly Hills Cataracts

Often, the density of the nucleus and the severity of the cataract relates to the patient’s access to healthcare. In … More

What am I thinking while doing cataract surgery?

It’s time for a fun video — what am I thinking while performing cataract surgery? I like the operating room … More

Optimizing the Red Reflex during Surgery

Illumination through the ophthalmic microscope is important for visualization during cataract surgery. We use a combination of both coaxial and … More

Doing Cataract Surgery on a Cataract Surgeon

It is always an honor when fellow ophthalmologists ask you to perform their cataract surgeries. It can also be stressful … More

Sub-Tenon’s Anesthetic Injection Technique

Placing anesthetic agents in the retro-bulbar space provides excellent anesthesia and akinesia during ocular surgery. We have previously shown the … More

What’s on my Cataract Surgery Instrument tray?

In this video I take you through my instrument tray for routine cataract surgery. As you can see in this … More

Review: Divide and Conquer Phaco Technique

Every July, we mark the beginning of the academic year in the USA and this is when our residents progress … More

Tilt and Tumble Phaco Technique

The Tilt and Tumble phaco technique is a very efficient and safe method of nucleus removal. First described many years … More

Foot Pedal Positions for Learning Phaco Chop

Cataract surgery requires both hands and both feet of the surgeon in order to perform the modern techniques. It seems … More

External View of Critical Cataract Surgery Steps

Two of the most critical steps in cataract surgery are the main phaco incision and the capsulorhexis. Properly completing these … More

Superior Incision: Hand Position & Microscope Views

While I prefer the temporal approach for routine cataract surgeries, some surgeons prefer a superior incision. Many beginning surgeons who … More

Simultaneous Hand Position and Microscope View

For young ophthalmologists, learning how to hold the instruments and position the hands during cataract surgery can be difficult to … More

Proper Hand Positioning in Cataract Surgery

This is a special video because the camera is focused on my hands for the entire surgery, from placing the … More

Technique for Retrobulbar Anesthetic Injection

To perform a safe cataract surgery and to keep the patient comfortable and pain-free, we need to give a sufficient … More

Analysis of a Resident’s 60th Cataract Surgery

As we get close to starting the academic year in the USA (which runs from July 1, 2019 to June … More

Hand Positioning during Cataract Surgery

When performing micro-surgery, particularly intra-ocular surgery like cataract surgery, a high level of precision is required. The surgeon’s hand positioning … More

Analysis of a Resident’s 50th Cataract Surgery (Part 2)

Continuing from the previous post, this is part 2 of 2 of the analysis of a resident’s 50th cataract surgery. … More

Analysis of a Resident’s 50th Cataract Surgery (Part 1)

This is Part 1 of 2 where we are analyzing an anonymous resident’s 50th cataract surgery, which is very early … More

Learning to be consistent: 12 consecutive incisions

We aim to be consistent in our surgeries so that we can make a well-constructed incision each and every time. … More

Review: Fully Separate Nucleus after the Phaco Chop

When doing phaco chop, remember that you must still physically push apart the nuclear halves to achieve complete separation and … More

Guest Surgeon teaches us Cataract Surgery Efficiency

We can always learn from fellow surgeons, particularly from those who are truly experts in the field. I recently met … More

What is your ideal Cataract Surgery case? Why?

What is your ideal cataract surgery case? Not your fastest case. Speed does not matter. Efficiency does, but that’s a … More

How to Flip Up the Epi-Nucleus for easy removal

Hydro-delineation can be helpful to separate the dense endo-nucleus from the epi-nucleus of the cataract. This makes is a bit … More

Sometimes Even Experts Struggle during Surgery

As we gain more experience and hone our surgical skills, we achieve the state of flow where the procedure progresses … More

If your Phaco Chop fails, simply revert to Stop-and-Chop

Sometimes we attempt to use phaco chop to divide the cataract nucleus, but we are just not able to achieve … More

Position the head so the iris is parallel to the floor

Proper positioning of the patient for cataract surgery is important for the comfort of the patient and the surgeon, but … More

The incision and capsulorhexis are your signature

I like to think of the phaco incision and the capsulorhexis as my “signature” on every cataract surgery that I … More

For loose zonules, bring the nucleus up and out

In this seemingly routine case, we find that the anterior lens capsule wrinkles when we attempt the capsulorhexis. This means … More

Technique for PSC Cataract Surgery in younger patients

Posterior SubCapsular (PSC) cataracts are more commonly found in our younger patients and in particular, they can cause difficulty with … More

Optimizing Surgical Flow for Efficiency & Safety

Establishing a consistent routine in the operating room is the key for both increased efficiency as well as increased safety. … More

Flip and Chop Phaco is Ideal for Routine Cases

The flip and chop phaco technique has been presented here before on many occasions because it is such an efficient … More

Various Approaches to removing the Epi-Nucleus

When we perform hydro-delineation, we separate the dense endo-nucleus from the relatively soft epi-nucleus. This is helpful in multiple different … More

What is the secret to patient fixation during surgery?

Many ophthalmologists have asked me how my patients are able to maintain fixation during cataract surgery under topical anesthesia. In … More

Why is this patient yelling at me and the staff?

This is a routine cataract surgery that goes well and without complications. What is unusual about this case is the … More

Should we do bilateral same-day cataract surgery?

On rare occasions, I will do immediate, bilateral sequential cataract surgery so that a patient can have both right eye … More

How important is Capsule Polishing in Cataract Surgery?

In modern day cataract surgery, we remove the lens material which keeping the capsular bag to hold the IOL. How … More

The Angle Sweep Technique to Remove Viscoelastic

When we fill the eye with viscoelastic, we push it with the greatest force into the opposite angle of the … More

Surgical Exposure is Critical in Cataract Surgery

Head positioning and exposure of the surgical field is important for success in phacoemulsification. The patient should be supine with … More

Phaco Incision Size: is smaller always better?

When it comes to incisions in the eye, it would seem that smaller is better. But is that always the … More

Routine Dense White Cataract Surgery

Finishing up our week of routine cataract cases, today we are reviewing dense white cataracts. In some parts of the … More

Routine Phaco Chop Cataract Surgery

Continuing with our series about routine cataract cases, today we present a routine phaco chop surgery. The cataract is chopped … More

Routine Flip-and-Chop Cataract Surgery

We have previously featured an instructional video for the Flip-and-Chop method of cataract surgery and there was a very strong … More

Why I love Routine Cataract Cases

Many of the articles and videos here at CataractCoach.com feature unusual, difficult, or challenging cataract cases. These are fun videos … More

How to remove stubborn sub-incisional cortex

During cataract surgery it is important that we remove all of the lens cortex in order to minimize post-operative inflammation … More