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APRIL 7, 2024 | EYEWORLD DAILY NEWS | 3 ASCRS ANNUAL MEETING DAILY NEWS worthwhile anymore. As physicians, we're taught to work and work and work, Dr. Fram said, and the patient always comes first. But she added that it also leads to a lot of physician burnout. The fact that we've chosen something to start doesn't mean that it's the best thing to continue to put time and energy into over time, Ms. Duke said, especially if you've gained information that it's not worthwhile anymore. When you make a decision to start something, by definition, you're going to learn new things, Ms. Duke said, but sometimes it's going to be an adverse signal that makes us change course. Dr. Fram went on to bring up Ms. Duke's "kill criteria," helping to know when to stop something. She praised her ophthalmology partner, Samuel Masket, MD, for knowing when to quit. "The day he stopped operating, he was just as good as he was when I started 15 years prior," she said. Regarding the kill criteria, Ms. Duke said, "We just aren't good at making that decision when we're in it." This is why you need kill crite- ria, and it's even harder when the thing we're doing is intertwined with our identity. The easiest way is to think in advance about signals and pre-commit to an action when you see those signals. She likened this to climbing Mount Everest, noting that one of the kill criteria for climbers is that no matter where you are on the mountain on summit day, if it's 1:00 p.m., you must turn around. However, not everyone follows this, she said. 'X-Factor: Women Leading by Example' Another part of Saturday's Main Stage session was the "X-Factor: Women Leading by Example." It absolute error and the percentage of eyes within refractive targets, he said. Dr. Weikert's lecture highlighted four groups of atypical eyes: long eyes, short eyes, keratoconic eyes, and post-laser vision correction eyes. Long eyes are generally thought of as greater than 25 mm. This is very common (8–16%, and you tend to underestimate IOL power, result- ing in hyperopic errors). With respect to axial length, Dr. Weikert men- tioned work by Li Wang, MD, PhD, and the regression formulas by Dr. Wang and Douglas Koch, MD. Going back to the beginning of biometry, Dr. Weikert said, as opti- cal devices evolved, the ability to measure individual segments of the eye improved. Even though we can measure individual segments, they're ignored when we're given the dis- played axial length, he said, adding that he did a study several years ago to look at this. We found that we could reduce prediction errors by us- ing segmented axial lengths in some formulas, he said. Short eyes are axial lengths that are less than 22 mm. We tend to overestimate IOL power in these, he said, which leads to myopic errors. Factors impacting errors in short eyes are a shallow anterior chamber, thick lens, shorter vitreous cavity, and high IOL powers. Meanwhile, for keratoconic eyes, these have variable measurements, contact lens influence. These eyes tends to underestimate IOL power, leading to hyperopic errors. In the post-LVC eye, Dr. Weikert said, IOL power may be under- or overestimated. Myopic ablation can lead to hyperopic error, and hyper- opic ablation can lead to myopic error. He said this is a common issue, noting that these are 10–14 % of cataract patients at his institution. Corneal power serves two roles in IOL power calculation, and LVC alters the anterior curvature. Ante- rior keratometry is poor estimate of true corneal power. Dr. Weikert also covered various formulas during his lecture and how they perform for these groups of eyes. Editors' note: Dr. Weikert has financial interests with Alcon, Carl Zeiss Meditec, and Epion. Guest speaker highlights "grit or quit" Author and former poker player Annie Duke took attendees through the delicate decision making of grit or quit in a conversation with Nicole Fram, MD, who moderated the session. When asked about how she be- came interested in the idea of "grit or quit," Ms. Duke said in our culture, grit is the hero. It's a sign of charac- ter. It's considered a virtue. On the other hand, quitting is considered to be a failure of character. You've given up, she said. "This was very frustrating to me for a couple reasons," Ms. Duke said. "The first being, grit and quit are the same decision." Grit gets you to stick to hard things that are worthwhile, but it can also make you stick to thinks that aren't worthwhile, and sometimes you should quit, she said. Ms. Duke mentioned her career as a professional poker player, adding that something that she understood from this is that folding is hard, but often it's the right thing to do. That's what separates the great poker player from an amateur, she said. They know when to fold. Profession- als understand putting resources in hands that are worthwhile. As soon as they realize it's not worthwhile, they should let go. Ms. Duke said that she wanted to write her book about getting people to walk away from things that aren't continued from page 1 continued on page 4

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