The need for cataract surgery is increasing rapidly due to an aging population, with demand projected to rise by 24% by 2035. In contrast, the number of ophthalmologists is expected to decrease by 12%, resulting in a projected workforce shortfall of 30%.¹ This discrepancy highlights the critical importance of high-volume cataract surgery in addressing this significant public health challenge. Meeting the rising demand requires not only technical expertise but also the capacity to perform surgeries at scale to ensure timely access to vision-restoring procedures for a growing patient population.

High-volume cataract surgery is both an art and a science. It requires a blend of technical skill, experience, and relentless passion. CRST posed five questions to a group of pioneers and leaders in high-volume cataract surgery. Their diverse perspectives shed light on what it takes to thrive in this demanding specialty.

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CRST: What is the most rewarding part of being a high-volume cataract surgeon? How have you maintained your passion for the field after performing thousands of procedures?

Several panelists cited the procedure’s impact on patients’ lives. Joaquin O. De Rojas, MD, told CRST, “Reaching so many people through high-volume surgery and seeing the effects in the community is incredibly fulfilling.” He enjoys the high-stakes environment where his work makes a significant difference.

Similarly, Asim Piracha, MD, said his feeling of satisfaction never fades because it comes from directly affecting patients’ lives, whether with the first or 50,000th case. He remarked, “The ability to bring joy and improve function in just minutes is unparalleled.”

Farrell C. “Toby” Tyson, MD, FACS, values the sheer volume of lives he has been able to affect positively. Gary Wörtz, MD, described cataract surgery as “a modern-day miracle” and reflected on moments of profound patient gratitude that continue to fuel his dedication, even after thousands of cases. Maria C. Scott, MD, identified patient interaction as the most rewarding part of her work, particularly the positive feedback she receives during day 1 postoperative visits. Charles H. Williamson, MD, FACS, FWCRS, highlighted the instant gratification of witnessing the immediate, profound impact on patients’ lives and the specialty’s technological advances.

Jeffrey Whitman, MD, perhaps summed up these responses best: “Helping thousands of patients. It’s really that simple.”

A few respondents focused on the satisfaction gained from executing a carefully crafted surgical plan to achieve success. Pit Gills, MD, commented, “Even after thousands of procedures, the thrill of achieving a perfect result remains, much like a basketball player still enjoying the perfect three-pointer.”

Priya M. Mathews, MD, MPH, added that cataract surgery itself is inherently fascinating. She finds immense excitement in customizing each patient’s vision to achieve the desired outcome, particularly in refractive cataract surgery. She told CRST, “It’s about crafting a personalized plan for each patient. The goal is to continually improve our level of customization while also increasing overall efficiency.”

Echoing that point, William F. Wiley, MD, cited the continuous improvement of his skills: “Even after thousands of cases, the learning never stops. This constant evolution keeps me passionate about cataract surgery.”

Meanwhile, Blake K. Williamson, MD, MPH, MS, finds reward in teamwork. He explained that “achieving excellent outcomes as a team” and fulfilling the noble duty of meeting the high demand for cataract surgery keep him motivated.

CRST: What is the most challenging aspect of high-volume cataract surgery, and how do you manage the associated stress?

Navigating the challenges of high-volume cataract surgery requires resilience, focus, and strategic management skills. Dr. Gills noted, “There’s little room for error, and the team must perform at its best throughout the day. Any lapse can quickly add up, affecting both quality and efficiency.”

Dr. De Rojas commented, “Managing the psychological impact of complications, along with the constant pressure to perform at your best, is difficult. Balancing consistency with the reality that not every day will be perfect is crucial.”

In addition to maintaining a realistic outlook themselves, surgeons must manage patients’ expectations. Dr. Piracha commented, “Even with perfect surgery, a dissatisfied patient can be demoralizing. Accepting that satisfaction isn’t always within your control helps in managing this aspect of the practice.”

Dr. Mathews discussed the need for mental discipline. She remarked, “It’s crucial to focus entirely on the patient in front of you, without worrying about the patients waiting behind them. Once you leave the room, it’s important to move on and not let the previous case linger in your mind.”

Dr. Scott agreed, saying “Compartmentalization is crucial for consistently producing great results, even when things don’t go as planned.”

A few respondents applied this thinking to the OR. Dr. Wörtz advised, “Focus solely on the current task, leaving any external distractions aside.” Dr. Charles Williamson added, “Sustaining high volume requires mental preparation, physical endurance, and a positive OR environment.” The vigilance demanded of the surgeon, however, can be taxing. Dr. Whitman noted, “Even after thousands of cases, the attention to detail required never diminishes. This constant focus, while essential, contributes to stress.”

Building and maintaining a high-performing team can help. Dr. Tyson stated, “Finding team members who share a commitment to quality and efficiency is essential for handling the high volume.” Managing a cohesive team, however, can be more stressful than the surgeries themselves. Dr. Wiley remarked, “The best surgeons excel not only in their surgical skills but also in their ability to inspire and coordinate their team.” Dr. Blake Williamson agreed, saying, “Managing your own performance while ensuring the team is in good spirits and functioning well is a constant challenge.”

CRST: What mindset or attitude do you believe is most critical for someone aspiring to excel in high-volume cataract surgery?

The panelists offered a variety of answers, but all of them argued against maintaining the status quo. Dr. Wiley stressed the importance of continuous self-reflection. “Never settle—optimize every aspect of your practice, from surgical techniques to patient processes,” he urged.

Dr. Wörtz advised focusing on continuous process improvement. “Eliminate inefficiencies and maximize your time in the OR by delegating tasks,” he said. Similarly, Dr. De Rojas commented that “constantly seeking improvement is essential. Without this mindset of continuous progress, achieving high-volume success is difficult.”

According to Dr. Scott, success requires stamina. She noted, “Building a practice requires years of relationship cultivation, community outreach, and staying current with techniques.” In addition to endurance, Dr. Gills emphasized the importance of the team surrounding the surgeon. He commented, “Handling long days in the OR requires tenacity, but a relaxed mindset and the right team make it enjoyable.” Dr. Tyson agreed, saying, “Success requires not just surgical skill but also investing in top equipment and staff who understand the mission.”

Dr. Piracha said it is important to “strive for perfection every time, even if it’s not always achievable. A holistic approach, with aligned preoperative workups, team coordination, and effective communication, is essential.”

Dr. Mathews highlighted the importance of making a significant impact in a short time. “In those few minutes with a patient, it’s essential to gain their trust, demonstrate your confidence and skills, and leave a lasting impression,” she said. “The key is to make every patient feel that you are fully focused on them and carefully considering their unique needs.” Similarly, Dr. Blake Williamson stated, “Managing the few patients who aren’t satisfied requires patience, and positivity is equally important—your attitude affects your team.

Dr. Charles Williamson emphasized adaptability. “Time management, attention to detail, and adaptability are vital,” he said. “Continuous learning and curiosity keep you at the top of your field.” In related remarks, Dr. Whitman said, “Develop reproducible surgical techniques and stay curious about new technologies and techniques to continually improve.”

CRST: How do you maintain your focus and mental sharpness throughout a long day of surgery? Do you have any specific routines or mental strategies that help you stay at your best?

A few panelists credited physical fitness and mental preparation for their ability to maintain focus during long surgery days. Dr. Mathews combines HIIT workouts for stamina and yoga for relaxation. She shared, “Physical fitness has improved my endurance in the OR, and yoga helps me unwind after an intense OR day. Mentally, I start preparing 24 hours in advance, ensuring proper rest and a clear mind before surgery.” She also highlighted the importance of family support, with a practical approach to balancing surgery with parenting duties.

Dr. Piracha cited a combination of mental and physical preparation. “Adequate sleep, a consistent morning routine, and fitness are key,” he said. “Achieving a flow state during surgery keeps me engaged and relaxed.” Dr. Whitman concurred, saying, “Regular exercise and health checkups ensure that I stay at my best, even during long surgery days.” Similarly, Dr. De Rojas remarked, “Endurance sports have helped me build the stamina needed for long surgery days. Starting the day with a clear mindset helps keep me calm and focused.”

Dr. Wörtz uses a holistic approach to stay focused. He commented, “Aligning mind, body, and spirit is essential. Adequate sleep, hydration, and music help keep me in the zone, while a supportive OR team reduces stress.” Other surgeons also emphasized the importance of the people around them. Dr. Gills stated, “The team’s support and a relaxed, focused mindset lead to a flow state, where the day’s challenges become enjoyable.” Dr. Scott highlighted the importance of a well-trained, respected team and shared, “Slowing down, showing genuine concern, and streamlining tasks during patient visits help reduce end-of-day workload and maintain focus.” Dr. Blake Williamson finds his flow state by establishing comfort and routine. He said, “This heightened awareness helps me quickly address any disruptions, ensuring consistent performance.”

Dr. Tyson focused on comfort in the OR. “Proper alignment of equipment and patient positioning prevent physical strain, and enjoyment of surgery days keeps my mind sharp,” he said.

Dr. Charles Williamson believes in blending precision with passion and fun. “Enjoying the work helps set a positive tone for patients and staff,” he said. Dr. Wiley stays engaged by focusing on the uniqueness of every case. “Each case’s nuances, from technical aspects to patient anatomy, ensure that the work never becomes monotonous,” he explained.

CRST: If there is anything you could go back in time and change about your approach or decisions, what would it be and why?

A few panelists wished they had been more patient. Dr. Wörtz said, “Reaching high-volume surgery success takes time and gradual refinement. It’s important to trust that each stage prepares you for the next, even when progress feels slow.” Similarly, Dr. De Rojas remarked, “Early in my career, I was eager to reach high-volume surgery quickly, but I’ve learned that it’s about sustained, gradual effort. Pushing too hard too fast can lead to burnout and suboptimal outcomes.”

Dr. Mathews wishes she had been less hard on herself during her early years. She commented, “There’s a lot of learning that happens in the first few years of practice. I’d tell my younger self to embrace the hard cases, build confidence, and not be too quick to blame myself when things don’t go perfectly. Complications are often multifactorial, and it’s important to maintain your confidence and keep pushing through.”

Dr. Scott would have prioritized her own health. “If I could change anything, I’d prioritize self-care and be more mindful of my posture,” she said. “A massage after each surgical day would have been a good habit.”

Dr. Gills reflected on the importance of relaxation. “Initially, I focused on speed to become a high-volume surgeon, but I’ve learned that relaxation brings natural speed and better outcomes,” he said.

Dr. Charles Williamson commented, “Building a high-volume practice often led to neglecting personal time. Achieving balance earlier would have sustained my effectiveness and well-being.”

Dr. Piracha shared that his early focus on complex cases delayed his transition to high-volume surgery. “However, those experiences developed skills that make me a better, more versatile surgeon today,” he said. Dr. Blake Williamson had a different perspective. “Initially, I was hesitant about IOL exchanges and LASIK enhancements, but mastering these skills sooner would have made me a better surgeon earlier in my career.”

Dr. Wiley wishes he had focused solely on his primary goals: “Early distractions, like adding Botox [onabotulinumtoxinA, AbbVie] or hearing aids, took away from my main focus—building a cataract and refractive surgery practice.”

Two respondents said they would not change anything. “Each step in my career, whether a success or a challenge, has been a learning experience,” Dr. Tyson remarked. “Now, I focus on passing those lessons to the next generation.” Dr. Whitman added, “A mentor taught me the importance of curiosity and never settling, which has shaped my career.”

1. Berkowitz ST, Finn AP, Parikh R, Kuriyan AE, Patel S. Ophthalmology Workforce Projections in the United States, 2020 to 2035. Ophthalmology. 2024;131(2):133-139.