5 Questions with David Spalton, FRCS, FRCP, FRCOphth

1. Since you entered the practice in the early 1980s, what would you consider the greatest advance in cataract or refractive surgery?
The evolution of phaco surgery is undoubtedly the greatest advance we have seen in cataract surgery. When I began as a resident at Moorefields Eye Hospital in London, intracapsular cataract extraction was the only type of operation performed. It was quite a daunting procedure requiring general anesthesia, and it required that the patient stay in the hospital for several days. In those days, we did not operate on people until their visual acuity was counting fingers or hand movements, because of the potential for complications. With phaco, that kind of outcome has become a distant memory.

Additionally, the routine use of IOLs was the next great advancement in the field of ophthalmology.

2. What do you see as the future of cataract surgery?
The future of cataract surgery will be found in better accommodating IOLs. I think that multifocal IOLs are a step in the right direction, but accommodating IOLs are the future for cataract surgery in the years to come.

3. What types of things do you hope to accomplish over the next 5 years of your career?
I would like to see the research we are performing on accommodating lenses be used to develop a practical and effective lens. Currently, my colleagues and I are looking at a new focus shift lens and researching another novel design lens as well.

4. How do you manage your practice?
I attempt to give a real quality service to patients and make sure they know that they are properly looked after. We try to get away from the mechanical attitude of processing patients, rather than looking after them.

We spend time talking to the patients to find out what they want, and try to match their expectations.

5. Who has influenced you in your practice?
There are several people who come to mind. Eric Arnott, MD, was a pioneer of implant surgery in the United Kingdom and influenced my cataract surgery a great deal. He was a beautiful surgeon and showed, at the time when implant surgery was quite controversial, that the operation could be done safely and well.

Additionally, Richard L. Lindstrom, MD, said something relatively small during a meeting in the early 1990s that changed my perspective on phaco surgery.

In those days, there was a lot of discussion about who was suitable for phaco. I remember him saying, "You have to say you are a phaco surgeon and get on with it." It was a very influential comment for me. It made me realize that sometimes a surgeon has to bite the bullet and make up their mind about what they want to do—and then they need to do it.

Sometimes the small comments that people make are the things that influence you the most.

Watching Howard V. Gimbel, MD, MPH, operate at his clinic in Calgary, Alberta, Canada, was also formative to me. I was very impressed by his management of patients and his surgery—it was sleek, efficient and there was no wasted movement in his technique.

Bonus Question:
What would people be surprised to learn about you?
I had to ask my wife about this one. She says people would be surprised to discover that I once had a full head of hair and a bushy red beard (for a few weeks)!