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Cover Stories | August 2021

Staying at the Forefront of Trends and Technology

Why it’s important to trust your instincts.

After completing my residency and a yearlong fellowship with my father, Stephen M. Weinstock, MD, the furthest thing from my mind was being the first ophthalmologist in the country to use a new technology. My only priorities were to become the best surgeon I could be and to serve my patients by giving them great visual outcomes using the tools and experiences from my training. Over time, my relationships with colleagues and industry, creativity, confidence, and a touch of luck led to opportunities to pioneer the development of new technology and work with new devices.

Surgeon availability and accessibility are crucial components of achieving goals and maximizing opportunities with industry partners. During the past decade, refractive cataract surgery has become one of the fastest-growing and most technologically advanced specialties in ophthalmology. I am privileged to play a role in this rapidly developing field, and I am fortunate to remain at the forefront of new technology.


As my practice grew, my primary focus shifted from giving patients great visual outcomes to offering them state-of-the-art refractive cataract surgery. Further, the pivot in our field to refractive cataract surgery and the growth in technology heavily influenced my decision to initiate an advanced anterior segment/refractive cataract surgery fellowship about 6 years ago. Not only has this decision changed my personal practice for the better, but it has also enhanced my enjoyment of medicine immensely. The learning environment that we created for this fellowship benefits the mentees as well as the mentors. It forces me to push the limits of my own comfort level and skill set and to evolve year after year. (Editor’s note: For practical tips on starting a refractive cataract surgery fellowship, see Watch It Now.)


Building a Refractive Fellowship Program

William F. Wiley, MD, discusses the importance of having staff, OD, and patient buy-in to foster success and longevity of a fellowship program.

One of the most important aspects of the fellowship we offer at The Eye Institute of West Florida is our fellows’ ability to observe and operate with heads-up 3D surgery using the Ngenuity 3D Visualization System (Alcon). Most of my experience with heads-up surgery stems from interactions with industry early in my career. Building these relationships and friendships opened countless doors and led to creative and innovative collaboration. As a result of my involvement with 3D technology, I can teach my fellows vital skills and use a detailed surgical teaching strategy that is not possible with a traditional analog microscope.

In my experience, heads-up surgery also promotes a unique operating suite environment that creates a team-based atmosphere. Everyone in the room can be in tune with the entire surgical process by wearing a simple pair of 3D glasses. Additionally, I can efficiently move in and out of our three ORs, quickly assess a fellow’s status during a procedure, and seamlessly assume control of a case if and when I feel it necessary to intervene. Operating in 3D also allows the surgeon and the instructor to operate and observe surgery while in a comfortable upright posture with good ergonomics, which helps to ensure a lifelong healthy surgical career. I credit the success and mastery that my fellows can and have achieved with the use of this unique technology.

In my experience, the efficiency, cost savings, and benefits of 3D visualization in cataract surgery are priceless.


In addition to running a busy practice and training a new fellow each year, I work to publish peer-reviewed articles, participate in clinical trials, and design studies that will benefit our specialty. This is one of the more challenging aspects of my career because of the diligence, time, and detail that these processes require. Collaborating with industry and incorporating the help of medical students and fellows, however, reduces the burden and can transform the laborious process into a more enjoyable one. Nevertheless, primary authorship and thorough guidance by a seasoned refractive cataract surgeon are necessary.

As my schedule has gotten busier over the years, the deadlines and opportunities have grown. A difficult lesson I learned early in my career is that time-sensitive requirements have little flexibility. I realized that I must do my best to address things as they come through rather than wait until the last minute. I strongly believe this perspective led to several opportunities during my career.

Each of us aspires to be successful in our chosen field. I have found that my definition of success often differs from that of my colleagues. Everyone has passions that forge a unique path. I draw inspiration and motivation, however, from industry giants such as Richard L. Lindstrom, MD; Robert H. Osher, MD; Vance Thompson, MD, FACS; Daniel S. Durrie, MD; Stephen G. Slade, MD, FACS; and Eric D. Donnenfeld, MD, all of whom continually embolden me to perform at a higher level year after year.


One aspect of medicine that is consistent wherever you are in your journey and always yields a positive result is putting patient care first. Additionally, maintaining a competent, happy staff and practice environment and providing strong leadership promotes natural success on many fronts. Finally, I advise my fellows to trust their instincts and pursue their passions. Doing so can create unique opportunities and successes that others might not have experienced.

Robert J. Weinstock, MD
  • Private practice, The Eye Institute of West Florida, Largo, Florida
  • CRST Chief Medical Editor
  • rjweinstock@yahoo.com
  • Financial disclosure: Consultant (Alcon)
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