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Jan 2013

5 Questions With Brian Little, MA, DO, FRCS, FRCOphth

How would you describe patients' acceptance of laser cataract surgery?

Laser cataract surgery has understandably created a groundswell of excitement and stimulated much debate among ophthalmologists. I remain unconvinced that the potential benefits of laser cataract surgery will offer significant benefits over those of phacoemulsification. The added precision of the femtosecond laser has not yet translated into tangible and functionally meaningful advantages. The adoption and success of this technology will probably depend less on sound science with objective reasoning and more on the public's demand generated by focused, persistent, and extensive marketing. Together with our patients, we must be wary of opinions that masquerade as truth. Patients' demand for laser cataract surgery exists because of the presumed benefits described in marketing materials. For the average cataract patient, however, the benefits of laser cataract surgery have yet to be convincingly demonstrated. In the words of the late, great Charles Kelman, MD, “Doctors debate, but patients decide.” Let us keep debating.

What is unique about your approach to treating patients?

I aim to treat patients as I would like to be treated. I greatly enjoy the varied and interesting people with whom I interact. I try to be friendly, welcoming, and respectful. I listen carefully to my patients to clearly understand the their problems as well as their expectations. The technical part of my job is always evolving and remains a positive challenge. The greatest challenges often derive from managing personalities (on both sides of the slit lamp).

What surgical cases do you find most enjoyable to perform?

There are two types of cataract cases that I particularly enjoy. The first involves patients with exceptionally high refractive errors (with or without astigmatism) who have never enjoyed high-quality vision. The surgery is usually relatively straightforward, although sometimes challenging, but the thrill of the visual result and its impact never diminishes. The second are complex and difficult cases that stretch me to my technical limits. They originate from a wide variety of sources (eg, previous trauma, congenital anomaly, genetic abnormalities, etc.). When the patient has visual potential, it is satisfying to use an array of microsurgical instruments, devices, and techniques to safely manipulate and control the intraocular microenvironment and bring about a successful result. The best outcomes are only achievable with an outstanding support team, which I am lucky to have where I work.

What is your most memorable experience as a volunteer in a developing country?

I have worked with Orbis for more than 15 years as volunteer faculty. I fondly remember a 23-year-old cobbler in a small village in rural Tanzania. He suffered from congenital cataracts and could no longer work. Consequently, the villagers could no longer work, because they all relied on him to repair their shoes, which they needed to walk to the fields. This domino effect meant that life in the whole village rapidly came to a halt, and the cobbler felt responsible. The stigma of visual impairment robbed him of any prospects for employment and marriage in his community.

After I removed one of the cataracts, I handed the cobbler a small mirror as he sat up on the operating table. He burst out laughing upon seeing his reflection, saying that he had never realized what a good-looking guy he was and that he would now be able to get married and return to work. The cobbler was back fixing shoes within 2 days, and the villagers returned to the fields over the next few days. I do not know if he got married, but at least he now stood a great chance!

What are your interests outside ophthalmology?

I enjoy editing videos and producing movies, although, admittedly, this is mostly work related. My interests are mechanically orientated. I have been a lifelong motorcyclist and enjoy touring the United Kingdom and Europe with close friends. I have a workshop for cabinet making, which has been an interest of mine since I was a teenager. Some years ago, I became an elected member of the Guild of Mastercraftsmen in the United Kingdom, which was a true honor. I built a convertible sports car in my 30s, which I drove for many years until my wife would not let me tie our three children to the luggage rack.

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