16January 10, 2022
Cataract Surgery & AstigmatismAstigmatism is a condition that prevents the eye from consistently focusing light in all directions. This highly common condition is induced by an abnormal curvature of the lens or the eye itself, resulting in more of a football shape instead of a
33December 29, 2021
Cornea - Cataract Surgery & Intraoperative OCTIntraoperative optical coherence tomography (iOCT) is a noninvasive imaging modality that provides a real-time dynamic feedback of the various surgical steps.
85December 11, 2021
Cataract Surgery SafetyThe main purpose of cataract surgery with phacoemulsification is to surgically remove the lens that develops cataract and thus to achieve the best visual acuity and to maintain visual function with an artificial intraocular lens (IOL).
52December 03, 2021
Cataract Surgery for Children & The Role of Femtosecond Laser Congenital cataracts and childhood cataracts are not very common. However, in the event that a child or infant has cataracts, it is not easy to predict how much their vision will be improved after the treatment.
66November 30, 2021
3D Cataract SurgeryThe benefits of 3D visualization in cataract surgery include improved ergonomics, high magnification optics, digital guidance systems that can be implemented in association with it, as well as collaboration with colleagues and educating residents and fell
61November 26, 2021
In light of Improving Clinical Outcomes For Dense Cataracts Lens fragmentation of a dense cataract requires a lot more phaco energy to emulsify the hard nucleus. More energy increases the risk of damage to corneal endothelial cells, which in turn can cause postoperative complications.
89November 22, 2021
Ocular Surface Disease Evaluation Before Cataract Surgery An impaired ocular surface adversely affects preoperative planning for cataract surgery, including intraocular lens (IOL) calculations, toric IOL axis and magnitude estimates, keratometry, and topography measurements. It also increases surgical difficulty
71November 17, 2021
Phacoemulsification With or Without Ultrasound Ciliary Plasty in Coexisting Cataract and Open-Angle GlaucomaCataract and glaucoma are leading causes of blindness all over the world (51 and 8%, respectively), that frequently coexist in the same eye.
79November 05, 2021
Suprachoroidal Hemorrhages During Cataract Surgery Suprachoroidal hemorrhage (SCH) is a rare but devastating complication associated with incisional intraocular surgery as well as trauma. Characterized as a sudden and rapid accumulation of blood within the suprachoroidal space
84November 01, 2021
Anterior Subcapsular Cataract SurgeryAnterior subcapsular cataracts (ASC) form after anterior lens epithelial cells become necrotic from a variety of causes including iritis, keratitis, inflammation associated with atopic dermatitis, irradiation, or electrical burns.
101October 24, 2021
CATARACT SURGERY - What If The SARS-CoV-2 Is Present in the Anterior Chamber?The Covid pandemic has profoundly changed the practice of ophthalmology. The availability of vaccines has greatly decreased the risk for infection in a large proportion of individuals in the United States, with 45.4% of the population having been fully
138October 18, 2021
Femtosecond Laser-Assisted Cataract SurgeryFemtosecond laser assisted cataract surgery (FLACS) is a recent development in the history of cataract surgery.
158October 13, 2021
IOL Calculations & Radial Keratotomy Calculating the intraocular lens (IOL) power in eyes with prior corneal refractive surgery is still a challenging task for all ophthalmologists.
200October 04, 2021
J&J Vision’s Next-Generation Phacoemulsification Machine “The VERITAS Vision System” The VERITAS Vision System is a modular ophthalmic microsurgical system that facilitates anterior segment (i.e., cataract) ophthalmic surgery. The modular design allows the users to configure the system to meet their surgical requirements.
222September 21, 2021
The ESCRS 2021 Will Witness The Launch Of Golden Ratio in Trifocal IOL Technology By VSY Biotechnology in Amsterdam, October 8-11 In light of its latest technology designed to provide patients with a high level of visual quality at near, far, and everywhere in between even at daily challenging light conditions; The concept of “Golden Ratio in IOL Technology” with its Acriva
214September 12, 2021
Aetna policy change requires preapproval for cataract surgeriesAetna began requiring that healthcare providers get preapproval for all cataract surgeries on July 1.
212September 10, 2021
World Lens Manufacturer Giant J&J is granted access by Health CanadaJohnson & Johnson Vision, the eye health subsidiary of Johnson & Johnson Medical Devices Companies, announced in a press release that its brand-new ACUVUE® Abiliti™ 1-Day Soft Therapeutic Lenses targeting myopia management in children have received green
297September 07, 2021
Single-Use Cataract Surgery Instruments & TASS Syndrome Given the technological developments in ophthalmic surgery, more intricate and precise surgical instruments are needed, especially micro-instruments, which are slimmer, more delicate, and precise.
209September 01, 2021
Cataract Surgery & Diseased CorneasPreexisting corneal disease can be exacerbated by cataract surgery and may prevent well-tolerated cataract extraction. The corneal epithelial, stromal and endothelial disease may impact and be impacted by cataract surgery.
273August 18, 2021
Metrovision Receives FDA Clearance for MonPackONE for Vision ElectrophysiologyMetrovision Receives FDA Clearance for MonPackONE for Vision Electrophysiology
PÉRENCHIES, France – Metrovision SAS, received FDA clearance for its MonPackONE Vision Monitor for vision electrophysiology applications including ganzfeld flash ERG and VEP,
282August 10, 2021
Cataract Surgery & Iris Fixation IOL TechniqueIn the absence of capsular support, the ophthalmic surgeon is faced with a number of choices for implantation of an intraocular lens (IOL). Myriad techniques have been described for fixation of an IOL either to the iris or the sclera in the ciliary...
273August 10, 2021
The New PENTACAM AXL Wave for Refractive Cataract SurgeryBY THOMAS KOHNEN, MD, PHD, FEBO, — Given the high expectations of today’s cataract surgery patients to achieve excellent vision at all distances, we are now tasked with providing refractive precision as the standard of care.
273August 08, 2021
What’s Hot In Social Media & OphthalmologyA round-up of the eye related hot topics that have been trending on social media over the last few weeks.
211August 06, 2021
Laser Cataract SurgeryThere are three steps within cataract surgery in which laser technology can offer a superior technique to the use of conventional hand-held tools.
The Corneal Incision
During cataract surgery, doctors make an incision into the cornea in order to access,
208August 03, 2021
Robotic Cataract SurgeryA fully automated robotic cataract surgery platform that extracts the nucleus and cortical materials has been successfully tested in pig eyes and could enter human trials soon.
The device uses a complete preoperative OCT scan to construct a model of the
231July 24, 2021
How To Manage Iris Prolapse During Cataract SurgeryIris prolapse is not an uncommon occurrence during cataract surgery. It usually occurs through the main incision during hydrodissection and is commonly associated with floppy-iris syndrome; however, it can manifest in cases with no known predisposition
217July 19, 2021
Not Only In Older Populations – Younger People Get Cataracts TooIt’s a common misconception that cataracts only affect the elderly. While it’s true that most cataracts occur because of aging, it’s not the only reason that cataracts can develop.
Many people start developing cataracts as young as age 40. However,
175July 16, 2021
The Link Between Cataracts & Bariatric SurgeryWeight-loss surgery can trim waistlines, and new research suggests it could also protect aging eyes.
The study found that after bariatric (weight-loss) surgery, a person’s odds for cataracts can drop significantly, especially among younger patients.
183July 15, 2021
1 in 4 Cataract Sufferers Are Likely to Get Surgery, J&J Vision Global Eye Health Survey RevealsJohnson & Johnson Vision announced study results revealing that only 21 percent of people diagnosed with cataracts (or who have cataract symptoms) are very likely to have surgery, meaning that the remaining majority (79 percent) are putting their
252July 14, 2021
Cataract Surgery & Retinal PathologyUnderstanding any structural abnormalities or pathology prior to cataract surgery is imperative.
Not all pathology is a contraindication to surgery, but it is critical to evaluate all findings to determine the patient’s visual potential with cataract
164July 13, 2021
Cataract Surgery & DiabetesDiabetes mellitus is a disease of elevated blood sugar due to insufficient production (type 1) or action (type 2) of insulin. Type 1 diabetes requires insulin injections, whereas type 2 is managed with diet, exercise, tablets or insulin injections,
175July 10, 2021
Diagnosing Irregularities In The Corneal Surface Before Cataract SurgeryBetter comfort, better high-contrast sensitivity (eg, Snellen chart) and quality of vision (less shadow vision, glare, or halos), and less fluctuation of vision are among the reasons to treat corneal surface irregularities in all patients, even in those
202July 06, 2021
Cataract Surgery & Neurolept AnesthesiaNeurolept anesthesia is a technique of general anesthesia based on intravenous administration of neuroleptic drugs, together with inhalation of a weak anesthetic with or without neuromuscular relaxants.
188July 05, 2021
Cataract Surgery & ZEPTODespite the appeal of an automated method of creating a perfectly circular anterior capsulotomy, global adoption of femtosecond laser capsulotomy (FSLC) has been limited by its high acquisition and per case cost.
In addition, the femtosecond laser’s
179June 25, 2021
TECNIS Synergy – Toric II PC-IOLS Available Now In North America For Cataract PatientsJohnson & Johnson Vision Brings TECNIS Synergy And TECNIS Synergy Toric II PC-IOLS To North America For Cataract Patients
The next-generation presbyopia-correcting intraocular lens (PC-IOL)offers cataract patients the widest range of continuous vision
144June 12, 2021
The Sharp Health Companion App & Cataract PatientsApps Changing How The Healthcare Industry Works.
The growth of new healthcare applications in the market was inevitable. These technologies have enabled patients and medical professionals to communicate in a more efficient manner.
144June 11, 2021
Cataracts Patients with Astigmatism – A Next-Generation Monofocal Intraocular Lens From Johnson & Johnson VisionJohnson & Johnson Vision Announces Launch of TECNIS Eyhance™ Toric II IOL with TECNIS Simplicity™ Delivery System, a Next-Generation Monofocal Intraocular Lens for Cataracts Patients with Astigmatism, in Europe
159June 07, 2021
Diabetic Retinopathy & Cataract SurgeryCataracts and diabetic retinopathy (DR) are the leading causes of acquired blindness worldwide, which is further compounded by the fact that patients with diabetes have an increased risk of developing cataracts.
169June 07, 2021
Enova® is Available Now in C Haptic Model – VSY Biotechnology GmbHThe launch of “ Enova – C Haptic Model IOL” has recently been announced by VSY Biotechnology GmbH.
Enova, the first and only 100% glistening-free, dry-packed hydrophobic acrylic IOL, requires no warming or special conditioning before surgery.
127June 03, 2021
Cataracts With Unusual Corneas & Light-Adjustable IOLsLight Adjustable Intraocular lens (LAL) are the only lens that allows post operative titrations in IOL power after the eye has healed and secured refractive stability post cataract surgery, facilitating customization an optimization of lens to achieve the
157June 02, 2021
Covid-19 & Cataract Surgery – PatientsIn light of dealing with Covid-19 and thinking more effectively about the details of eye care, in every sense of the word, there is still too much work to do.
The ongoing fallout from the coronavirus disease 2019 (COVID-19) pandemic has resulted in
122June 01, 2021
Cataract Surgery – Dry Eye Disease & A Poor Tear FilmThe integrity of the ocular surface plays an important role in the success of cataract and refractive surgery. Treatment of dry eye disease (DED) is becoming an integral part of primary eye care, and optometrists are poised perfectly to initiate treatment
158May 30, 2021
The CapsulotomyCapsulotomy is a type of eye surgery in which an incision is made into the capsule of the crystalline lens of the eye. In modern cataract operations, the lens capsule is usually not removed.
The most common forms of cataract surgery remove nearly all of
135May 25, 2021
Cataract Surgery & SedationCataract surgery is performed almost exclusively as an outpatient procedure. It usually involves the administration of a local anesthetic in addition to systemic sedation administered by an anesthesiologist or nurse anesthetist.
151May 22, 2021
The Biochemistry & Biophysics of Cataract FormationCataracts progress in stages, but the development of the condition depends on age, exposure to UV experienced over a lifetime, genetic factors and some lifestyle factors, such as smoking, high alcohol consumption or nutritional deficiencies.
May 17, 2021
Intraocular Lens Manufacturing – State of the ArtThe human eye functions to provide vision by transmitting and focusing light through a clear outer portion called the cornea, and further refining the focus of the image onto a retina by way of a crystalline lens.
The quality of the focused image depends
158May 13, 2021
What Is The Best Lens For Your Cataract Surgery?Cataract surgery— One of the most important decisions you will have to make when it comes to cataract surgery is selecting an IOL. IOL is short for “intraocular lens”. Cataract surgery involves removing the eye’s clouded lens and replacing it with a clear
136January 22, 2021
Fuchs’ Dystrophy & CataractsFuchs’ dystrophy is a disease of the cornea. It is when cells in the corneal layer called the endothelium gradually die off.
These cells normally pump fluid from the cornea to keep it clear. When they die, fluid builds up and the cornea gets swollen...
431October 30, 2020
UN adopts first resolution on vision, aims to help 1 billionUNITED NATIONS — The U.N. General Assembly approved its first-ever resolution on vision Friday, calling on its 193 member nations to ensure access to eye care for everyone in their countries which would contribute to a global effort to help at least 1.1 b
27January 05, 2022
Cataract Surgery & Glaucoma Filtration ProceduresCataract and glaucoma are the leading causes of blindness worldwide. The prevalence of both diseases is increasing with aging population. Techniques for cataract surgery have undergone significant refinements with excellent visual outcomes.
30December 31, 2021
Association Between Cataract Extraction and Development of DementiaResearchers Find Evidence That Cataract Surgery May Lower Risk of Developing Dementia.
76November 29, 2021
Dysphotopsia & Cataract SurgeryDysphotopsia is one of the most under-recognized complications following otherwise unremarkable cataract surgery.
98November 13, 2021
Cataract Surgery – Glaucoma & Combining Laser With MIGSThe glaucoma surgical landscape has significantly changed in recent years. The conventional treatment paradigm began with hypotensive drops, laser surgery and traditional filtering surgery such as tube shunts and trabeculectomies.
76November 10, 2021
Cataract Surgery & Fuchs’ Endothelial Corneal Dystrophy (FECD)Fuchs’ endothelial corneal dystrophy (FECD) is the most common indication for corneal transplantation around the world, comprising 39% of all transplant operations.
78October 26, 2021
Clinically significant cataract linked to increased risk of vascular deathClinically significant cataract is associated with an increased risk of death from vascular causes, such as stroke and heart attack, suggests research published online in the British Journal of Ophthalmology.
134October 01, 2021
Crystalens & Cataract Surgery The Crystalens is an FDA-approved intraocular lens for the visual correction of adults with cataracts (clouding of the eye's natural lens secondary to age) with or without presbyopia, or lenses that have aged or become more rigid.
175September 27, 2021
Goniotomy and Cataract SurgeryWhile the Ocular Hypertension Treatment Study (OHTS) provided a guiding principle for patient care, it left ophthalmologists with a lot to think about.
171September 22, 2021
The 39th Congress of the ESCRS | Amsterdam 8 - 11 October 2021The 39th Congress of the ESCRS is planned to take place live in Amsterdam in a face-to-face format with limited seats available, ensuring a safe event. The confirmed dates at the RAI Congress Centre in Amsterdam are: 8 – 11 October 2021.
157August 28, 2021
Ophthalmology Specialty & Cataract Surgery Training Ophthalmologists are physicians specializing in the comprehensive medical and surgical care of the eyes and vision.
139August 19, 2021
Dexamethasone Intraocular Suspension In Cataract SurgeryCataract surgery is the most commonly performed surgical procedure worldwide. Despite the availability of new technologies and enhanced surgical techniques, inflammation-related complications after even uneventful cataract procedures remain the most
152May 17, 2021
147January 20, 2021
Cataract Surgery Prolongs LifePeople who underwent cataract surgery were more likely to be alive 10 years later, compared with those who continued to have vision problems. It’s possible that this surgery may improve physical and emotional well-being, contributing to the longer life...
283January 01, 2021
A New Post-Cataract Surgery Antibiotic/Steroid – Ducressa®Santen Pharmaceutical is one of the world’s leading specialist ophthalmic pharmaceutical companies, founded in Japan over a century ago and now serving patients all over the world.
Santen EMEA has recently announced the launch of Ducressa®, a fixed...
29December 29, 2021
Diabetic Retinopathy & Cataract SurgeryCompared to non-diabetic patients, outcome after cataract surgery was reported to be worse in diabetic patients--especially in those with diabetic retinopathy.
46December 25, 2021
Cataract Surgery & Its FutureMany people develop cataracts in addition to presbyopia as we age. A cataract is a clouding of the eye’s natural crystalline lens, creating blurriness that cannot be corrected with glasses or contact lenses.
42December 20, 2021
Pre-existing Astigmatism & Cataract SurgeryIrregular astigmatism occurs when the angle between the axis of maximum curvature and minimum curvature is not a right angle or when the curvature of a refractive surface is not axially symmetric, and often cannot be corrected with spectacles.
61December 09, 2021
Does One Size Fit All When Picking IOL In Refractive Cataract Surgery?
53December 06, 2021
Minimizing Inflammation After Cataract SurgerySome patients may complain of slight discomfort after cataract surgery. It may range from mild to moderate discomfort depending upon patient’s sensitivity and type of procedure used for cataract removal.
52December 02, 2021
Refractive Cataract Surgery - Patient Needs & IOL Performance Modern multifocal IOLs can be considered as a surgical treatment not only for cataract but also for refractive purposes when implanted after clear lens extraction.
87November 07, 2021
Cataract - Glaucoma & My Algorithm Treating glaucoma in the light of an impending cataract surgery is dependent on the patient’s current disease status – with intraocular pressure, current medication burden, and angle anatomy being the biggest features.
152September 15, 2021
Cataract Surgery & Poor MydriasisThe maintenance of mydriasis and the control of postoperative pain and inflammation are critical to the safety and success of cataract and intraocular lens replacement surgery.
310September 13, 2021
Intraoperative Aberrometry – Cataract Surgery & IOL Selection Intraoperative wavefront aberrometry aims to improve refractive outcomes following cataract surgery by optimizing the spherical power of the intraocular lens implant or calculating the appropriate axis and power of toric lenses during cataract surgery in
256September 02, 2021
Cataracts & Photodynamic Therapy - Central Serous RetinopathyCentral serous chorioretinopathy is a common acquired maculopathy. Multiple studies showed that photodynamic therapy is useful treatment for acute and chronic central serous chorioretinopathy.
158August 24, 2021
Cataracts & Floppy Iris SyndromeIntraoperative floppy iris syndrome (IFIS) occurs in 2% of cataract surgeries and is associated with an increased risk of surgical complications.
These complications can be avoided when high-risk patients are identified by preoperative screening and
386August 17, 2021
Complications Of Cataract SurgeryCataract surgery dates back to the 1700s. With new advancements in technology, infectious disease control, and equipment, there are fewer postoperative adverse events following the procedure.
However, complications still do occur both intra and
164August 10, 2021
Rayner Announces 1,000 IOLs Recorded on RayPRO Digital PlatformWorthing, United Kingdom. Rayner, the pioneering manufacturer of intraocular lenses for cataract and refractive surgery, announced that it has achieved the milestone figure of 1,000 intraocular lenses recorded on RayPRO, its digital patient reported outco
241August 03, 2021
The CataRhex 3 is now available with the unique Speep Pump innovation by OertliUsing its innovative developments and high-quality products, Oertli is continuously setting new standards in cataract, vitrectomy and glaucoma surgery.
Oertli’s surgical platforms, technologies and instruments allow surgeons and OR personnel to perform
175July 29, 2021
GONIOTOMY AND CATARACT SURGERYGONIOTOMY: A SURGERY TO LOWER EYE PRESSURE
When eye drops or lasers are unable to adequately lower eye pressure, goniotomy can be considered. Goniotomy may allow for eye pressure control with or without the use of glaucoma medications.
For patients who
124July 23, 2021
Refractive Cataract Patients & DED TreatmentThe development of visually symptomatic cataract is common. Cataract surgery is one of the most frequent and successful interventions currently undertaken.
Modern small-incision cataract surgery offers excellent clinical outcomes coupled with rapid...
159July 11, 2021
Information for Cataract Patients Undergoing SurgeryThe Cataract
Your eye surgeon has recommended cataract surgery because the lens in your eye has become cloudy making it difficult for you to see well enough to carry out your usual daily activities.
If the cataract is not removed, your vision may stay th
165July 08, 2021
Cataract Surgery & Patients With Herpetic DiseaseCataract surgery in patients with herpetic disease can pose unique challenges but, with the right planning, you can achieve great results.
Before surgery, you need to identify a “quiet window”, get your readings, and decide upon the appropriate surgical
167July 03, 2021
Latest Refractive TechnologyWith cataract surgery regarded as the most widely performed surgical procedure, a demand exists for continued innovation and technology.
The latest advances evolved through application of well-defined principles to current surgical goals and patient
259June 30, 2021
Cataract Surgery & Phaco Power ModulationToday, the aim of cataract surgery is not only to restore vision by removing and replacing the cataractous lens, but also to simultaneously provide instant and high-quality visual rehabilitation.
Achieving a clear cornea immediately after surgery
148June 29, 2021
Cataract Surgery & IOL PsychologyEye surgery has been performed for over 1,000 years. Ancient Romans and Indians were performing ‘couching’ surgery on cataract-affected eyes as far back as the 5th century BC.
This surgery was extremely crude – the surgeon having to use a needle to slide
125June 19, 2021
Cataract Surgery & Iris Prostheses
116June 14, 2021
The Role Of Premium IOLs & Posterior Corneal ElevationPosterior corneal elevation very effectively discriminates keratoconus from normal corneas. Its efficacy is lower for subclinical keratoconus, and thus data concerning posterior elevation should not be used alone to stratify patients with this condition.
130June 09, 2021
The Popularity of Monofocal IOLsAs cataract and refractive surgery improves, patients’ demands grow – “perfect” vision, with good near and distance focus, is now want many patients want.
Monofocal intraocular lenses are one way of achieving the best possible range of vision for patient
211June 04, 2021
Cataract Prophylaxis, Treatment & Pharmacological ApproachesCataract surgery has become remarkably safe and effective, thanks in part to a general trend toward decreasing postoperative infections. However, retrospective clinical evidence indicates a rise in endophthalmitis following clear corneal
137June 01, 2021
How Wine Consumption Reduces CataractsNew Study Reveals; Wine consumption may reduce Cataracts… Only Wine, Not Other Alcoholic Drinks!
The wine antioxidants play a role in cataract prevention!
People who consume alcohol moderately appear less likely to develop cataracts that require surgery
148May 27, 2021
Relation Between Surgeon Age & Postoperative OutcomesHigh-quality surgical outcomes require sound knowledge, communication skills, clinical judgment and technical proficiency.
The effect of aging, namely cognitive impairment, decline in visual acuity and worsening motor function, may negatively affect
137May 26, 2021
Cataract Patients – Ocular Surface & Good NutritionThe tear film is the most important refracting surface of the eye, and improving it can increase a patient’s quality of vision.
Cataract surgery deleteriously affects the ocular surface due to the neurotrophic effect of the corneal incision and the use
135May 23, 2021
Managing Irregular Astigmatism During Cataract SurgeryAstigmatism is a common eye condition that exists when the surface of the cornea or crystalline lens is irregularly shaped. It is a form of refractive error that can be present alone or in combination with myopia and hyperopia. Its correction requires
129May 20, 2021
Premium IOLs & Glaucoma PatientsPremium lenses – which defined as toric lenses and multifocal or extended depth of focus (EDOF) lenses – are sophisticated devices; but are they right for glaucoma patients?
The brief answer is that ideal outcomes require careful matching of IOL options
188May 10, 2021
Astigmatism Correction During Cataract SurgeryMost of the cataract surgeons don’t routinely address astigmatism in patients undergoing cataract surgery.
Most patients’ refractive astigmatism increases after cataract surgery. That’s because preoperative corneal astigmatism is greater than manifest
218May 10, 2021
Cataracts & Protein ImbalanceThe human eye lens exhibits many biochemical properties that are unique amongst the tissues of the body. The dual requirements of high transparency and high refractive index necessitate a high protein concentration.
133January 22, 2021
New IOL Treatment Planner From ZubisoftZubisoft and IBRA have released a new IOL treatment planner, which is now a part of IBRA Cataract Services.
In addition to higher visual acuity, the new planner allows surgeons to achieve more accurate results. The lower rate of necessary retreatments...
136January 22, 2021
Cataract Surgery & Dropless – Perioperative TreatmentsCataract surgery is the most commonly performed ocular surgery and one of the most frequently performed surgical procedures worldwide.
The vast majority of patients undergoing cataract surgery (99.5%) has a successful result with no serious adverse...
139November 12, 2020
Proactive Practice Growth Strategies For Cataract SurgeonsA written strategic plan is crucial to long-term success. The plan represents intentionality—that is, the practice is not drifting from one random expedient to the next.
It is, rather, intentionally pursuing a logical, linear progression of opportuniti