The Signature of the Cornea

In today’s digitalised operating theatre, a surgeon can sometimes feel more like a technician. The AI-calculated lens powers, the robotic lasers, the real-time feedback on every screen — all of it makes surgery look like a mathematics problem solved before you pick up the first instrument. But cataract surgery is not simply replacing a clouded lens with a clear one. It is the act of rebuilding a person’s connection with the world.

Early in my career, I was posted to a small district hospital in rural Anatolia. One morning, an elderly man arrived alone. He had mature cataracts in both eyes and had been living in near-total darkness for years. He had no money to travel to the city, and no one to take him. I told him his cataracts were hypermature and that a referral centre would be safer. If anything went wrong here, there was very little I could do. He listened, then said he had no way of getting there. He asked if I would operate anyway. I said yes. What weighed on me was not the equipment. What we did not have was anyone else. No retinal specialist down the corridor, no experienced colleague to call, a scrub nurse who was learning alongside me. If a complication had arisen, the nearest vitreoretinal surgeon was an hour and a half away, and it was clear this man could not get there. If it came to that, I would have driven him myself.

I remember the atmosphere before we started. It was not the usual quiet efficiency of a busy list. There was a heaviness, the kind that settles on you when the margin for error is small and the stakes feel personal. When he lay down on the table, he reached out and grabbed my hand. It was trembling. I held it for a moment. What I felt was something no digital readout has ever given me: fear mixed with hope, pressed into my palm.

The surgery went well. Later that day, I removed the eye pad. He looked around the room silently. Then he asked something I was not expecting: whether he could keep the surgical blade rather than have it thrown away. I asked why. He told me that before his vision had gone, he used to carve wood. Small objects, nothing fancy. The blade looked sharper than anything he had at home. If it worked, he said, he would carve something for me. A gift, made with eyes that could finally see again.

I gave him the blade. At his one-week follow-up, he walked in and placed a small wooden bird on my desk. He had carved it himself, at home, with a 2.2mm keratome. It was not perfect. It was exactly right.

That was when I understood something I had not fully grasped in training. We are not just removing a cloudy lens. We are giving someone their remaining years back, and sometimes their hands back too. But I also understood something else: if a flawless algorithm had performed that surgery, he would have walked out with the same vision. What he would not have had was someone to ask. You cannot turn to a robotic system and say: keep the blade, I think I still have something left in these hands. And it would never have occurred to a machine to say yes.

I think about this often, especially now that I work in a tertiary centre where a vitreoretinal surgeon is one call away and a complication is a problem to be solved rather than a crisis to be survived alone. But before every operation, I still touch my patient’s hand. Not out of habit. It is a reminder that the person in front of me is not a case or a biometry printout. They are someone who has been waiting, perhaps for a long time, to see again.

AI can tell me the optimal incision angle. It cannot tell me that the blade I am about to dispose of might end up carving a bird. That moment, quiet and unexpected and entirely human, is something no algorithm can prepare you for. You only learn it by being there, by holding a trembling hand in a small hospital, and staying curious about what comes next.

That man taught me, without knowing it, that the human relationship in this work is not a soft add-on to the technical side. It is where the real things happen. Now, with every tool I could ask for, I still make time before each case to sit with my patient for a moment. Not to check a box. Because somewhere in that conversation, there may be something I cannot afford to miss. That bird still sits on my desk to remind me.

Dr Akgöz Koyuncuoğlu is a finalist in the 2026 John Henahan Writing Prize.

Applicants were asked to respond to the following prompt, without using any AI tools:

The digital OR, AI algorithms, and robotics notwithstanding, cataract and refractive surgery involve a human relationship between you and your patient. Please describe how an experience or experiences in your early training reminded you of the importance of the human touch and how this has inspired you in your clinical practice.