As we hear time and again, from many corners of medicine, patient expectations—or, more specifically, managing patient expectations—play a key role in the perceived success of a surgical procedure.

I was reminded of this while looking over this month’s features. Taken together, they’re almost like a rogues’ gallery of ophthalmic surgeries that revolve around patient expectations. In one, “Cataract/IOL Surgery After RK,” you’ve got the first mass-market refractive surgery, radial keratotomy. When RK was first introduced, you can imagine the grandiosity of the expectations harbored by spectacle wearers. Though the surgery turned out to be successful in many cases, there were of course those that didn’t go as well. Also, it turned out that progressive hyperopia was a possible concern. Now, these same patients are coming in for cataract surgery which, ironically, would probably go very smoothly if it weren’t for their RK. Once again, as in the 1980s and 1990s when they got their RK, expectations needed to be tempered.

In another of this month’s features, we fast-forward to one of today’s expectation-laden procedures: premium intraocular lenses (“Responding to Premium IOL Setbacks,” p. 42). Though the survey cited in the article notes that patient expectations aren’t a leading cause of dissatisfaction after these lenses’ implantation, surgeons still spend a good deal of time managing expectations preop. As Baylor’s Zaina Al-Mohtaseb, MD, says in the article, “Cataract surgery has become a refractive procedure. High patient expectations and new lens technologies require correction of spherical error, astigmatic error and, in some cases, presbyopia.”

This discussion of patient expectations and the need to make them more realistic got me thinking about how we all get our hopes up for all kinds of things, every day. Of course, the biggest example of this, at least recently, is the pandemic. We went from expecting it to be isolated to another country to realizing we’d need to wear masks and social-distance for a year or more. Despite this, we still held on to the expectation that a vaccine would bring everything back to normal again. The vaccines arrived, and have been great for keeping us out of the hospital but, in terms of a complete resolution of the pandemic, we learned that we had to adjust our expectations yet again. A return to normalcy may be coming, but it won’t happen as quickly as we’d hoped.

We’re going to get through this, but it’s going to take more work than we thought to become immunologically “20/Happy.”

Speaking of happy, what could make you happier than leaving work behind and spending all of your time with family and friends? Well, this is what Senior Editor, Sean McKinney has to look forward to as he retires this month after 50 years of work, many of it spent making quality contributions to ophthalmic journalism. We wish Sean all the best on a well-deserved retirement. Sean, thanks for your hard work and friendship.


— Walter Bethke
Editor in Chief