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Editorial Spotlight | Sept 2019

What I Would Tell my Younger/Future Self

A father and son look forward and backward.

Pearls From a Seasoned Ophthalmologist

Thoughts on life and career from an ophthalmologist with decades of experience.

Arthur B. Cummings, MB ChB, FCS(SA), MMed(Ophth), FRCS(Edin)

As we get older, even though our bodies are aging and our outward appearance may change, mentally and psychologically we still think we are 17 years old—or somewhere thereabout. This seems to be universal. It always encourages me when I see 90-year-old patients who view themselves as being the same person they were 60 years before.

With that in mind, I am not going to be able to present some great revelation on how differently I would have done things when I was younger, given the life experience I have now. I’ve always maintained the same attitude toward life, from my teenage years all the way until now. It’s a very basic philosophy, along these lines: If you work hard, you are more likely to succeed. Success is viewed differently by different people, and it’s important for you to know how you personally view success. Respect is a two-way street, and the more you give, the more you receive. And finally, to have a presence, you need to be present.

Simplified, that means you need to say what you mean and mean what you say. It also means that, if you walk by somebody and ask how he or she is doing, you should expect to take a minute to actually have that conversation. This is the way I’ve seen things since way back when I started my career, and not much has changed today, even though there have been a few decades in between.


Build business acumen. Given how things have changed in our space over the course of my career, there are things that I could have done better, and situations in which I could have paid more attention, that would have been valuable at this point in my career. Having a good basic business sense is imperative in modern private practice, especially in a field such as ophthalmology, which is capital-intensive and requires ongoing investment into the business in order to continue providing the best level of care.

Another thing that would have been valuable to my career in ophthalmology would be learning early on how to deal with demanding patients. The success that we have achieved with laser vision correction has now caused a rise in patient expectations in cataract surgery. Anything that could help one assess psychological risk and manage today’s sky-high patient expectations would be a skill worth investing in.

Prioritize relationships. Ophthalmology is a wonderful vocation—for some, a calling—so it is possible to be sucked into it completely at the expense of personal and family relations. It’s very important, as your career progresses, to pay equal attention, if not more, to your personal and family life. Success is ultimately a goal, but it is much more fulfilling to be successful when you are surrounded by real supporters rather than alone. Fortunately, I did invest in my family and do not have many regrets on this score—although it would have been nice to take more frequent and longer family holidays.

Don’t be too competitive. I would tell any young colleague not to be too concerned with how your peers are doing and to behave less competitively. A lesson to be learned from elite sports performers is that the best way to achieve success is to keep your eye on the goal and put in the effort required to achieve that goal without looking over your shoulder all the time.

Of course we need to benchmark, and we need to stay abreast of current developments, but don’t be distracted by what others are doing. Simply set yourself an objective and do your best to achieve it. Additionally, routinely reevaluate your goals to ensure that they are still aligned with your core values.

Be self-aware. Do not underestimate what you can achieve. All of us are human and are therefore subject to human frailties and doubt. Don’t judge others as you walk your own path and face your own challenges. I’ve met some incredible colleagues along the way who are, by all accounts, the most successful in our field—yet each of them has a vulnerability and an area in which they believe they can improve.

Don’t underestimate the value of self-awareness and of value-based leadership. Remember that, to be a good leader, you need to be a good follower as well. It is not possible to succeed at everything you do all the time; hence, it is important not to be too self-critical.

Be authentic to yourself. I am not sure that I am really in a position to tell my younger self how to do things differently. Everything I did, I did to the best of my ability at the time and with the goal that I believed was most important to me.

It all comes down to being authentic to oneself. If we do this, it’s difficult for anyone else to direct us as to how to live our lives or run our careers. Learning from your mistakes and always being willing to learn—even from the least likely of sources—can go a long way to making your career more fulfilling and creating long-lasting friendships among like-minded colleagues.

Break it down. Sometimes we are so inundated with to-do lists that the challenge seems insurmountable. The trick is to break that challenge down into smaller, doable parts, and to simply do the best that you can at that moment with that particular task and keep on working away at it. Persistence and consistency are keys to success that are often overlooked. These two traits often trump talent and skill.

Be grateful. The final item that I would tell my younger self is to be grateful for this wonderful opportunity to serve our fellow humans through vision correction and ophthalmology and to make the most of it at every opportunity.

We are in a field with a disproportionately high percentage of people who are very happy with their career choices, and we need to be aware of those around us who are not quite so fortunate. Treat others with respect and empathy, and your career will provide you with much contentment and fulfilment.

A Letter to My Future Self

A young surgeon looks back while looking ahead.

Brendan K. Cummings, MB ChB, BAO, MRCSI(Ophth)

I hope you, Brendan, are still as excited to go to work as I am as I write this today. If, however, waking up for work tomorrow seems like a chore, here are a few reminders of how lucky you are to be doing this job.


Do you remember the absolute joy you felt when you were offered a place in medical school? Do you remember the moment you first saw an iris through a slit lamp and decided that, if you had to look at one body part every day for the rest of your life, it was definitely going to be the eye? What about the day you got the call with an offer for the ophthalmology specialist training scheme? Well, that young man’s dreams are your reality, buddy, and don’t you forget it!

I hope you haven’t forgotten how excited you felt the first time you did a cataract surgery on your own. Not the nerves or the pressure, but the sense of accomplishment and pride in having changed that patient’s life for the better. Your first cataract patient was a retired teacher who cared for his frail wife and had lost the ability to drive because of his cataracts. He smiled at you upside down on the operating table and promised to light a candle for you that weekend at Sunday Mass. Well, remember that all of your patients have their own stories about their failing vision and the little or large challenges that take up more and more of their lives. And you—you—are equipped to help ease their burden. If you focus on your patients’ specific, personal visual challenges, you will be as excited to help every patient as you were your first.

Do you remember how sincere and earnest you were the first time you led a patient through informed consent for a procedure? The patient was scheduled for bilateral punctal cautery but refused to sign the consent form because she found her eyes much too watery after getting punctal plugs. I hope you have by now had a few more patients, like her, decide against surgery because you have taken the time to be clear. Hopefully, this has helped to avoid several unhappy patients and happy lawyers.

I’m not sure how you people in the future remove cataracts, but please, don’t get lazy with the steps, and always make sure you’ve done a good hydrodissection!


I know I won’t have to remind my future self what an inspiration his Dad has been. Not only the chats about technical details that were often over my head, but also the lessons about making a success out of any venture in life. Remember the 3 A’s: be Able, Available, and Amiable, and make sure your Attitude is right, too, because that will determine your Altitude.

And then there is something he never said out loud but I—and anyone who knew him—managed to pick up on anyway: If you want to have the credibility to some day tell your children to chase their dreams, work hard, and be ambitious, then you must be brave enough to live your own life the same way.

I’ve always loved that Mark Twain quote: “When I was 14, my father was so ignorant I could hardly stand to have him around. When I got to be 21, I was astonished at how much he had learned in 7 years.” I find that funny because every time I think I’ve understood my Dad’s wisdom, it seems he’s packed in another 7 years of learning in the intervening time. Future Brendan, I hope you’re still trying to catch up.

Arthur B. Cummings, MB ChB, FCS(SA), MMed(Ophth), FRCS(Edin)
  • Consultant Ophthalmologist, Wellington Eye Clinic and Beacon Hospital, Dublin, Ireland
  • CRST Europe Associate Chief Medical Editor
  • abc@wellingtoneyeclinic.com
  • Financial disclosure: None
Brendan K. Cummings, MB ChB, BAO, MRCSI(OPHTH)
  • Ophthalmology Specialist Registrar, Temple Street Children’s University Hospital, Dublin, Ireland
  • brendan.cummings@ucdconnect.ie
  • Financial disclosure: None