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We would like to begin by thanking Zabalza et al for their thoughtful questions and comments. In our article, we describe complication rates by year of residency. We certainly think that correlating complications with surgical experience on a resident-by-resident basis is an interesting topic, however, we feel it is a separate question. We are not seeking to elucidate the mechanisms of the resident learning curve for phacoemulsification. Rather, we are trying to draw conclusions about the overall complication rate for residents of a particular level. Since residents have varying levels of exposure to particular surgeries and natural ability (and since we as teachers can control neither), studies are needed that examine the issue in aggregate in order to inform teaching policy. The concern with such an aggregation of data, as Zabalza et al point out, is the possibility of bias. We believe that a 5-year study helps us in this regard as the effect individual differences among residents skill and experience levels are reduced by the number of residents involved. Furthermore, because the data is longitudinal (the same residents contribute data to the second- and third-year datasets), residents are in effect being compared with themselves. Our cases were selected retrospectively based on the criteria that the resident performed the majority of the case. As we discussed in our article, we had sufficient power to detect an odds ratio of 2 or more when comparing overall complication rates among second- and third-year residents. The fact that we found no significant association does raise the issue of the timing and degree of attending intervention. However, we feel that developing a clinical guide to intraoperative management of resident complications is a separate topic and our study was underpowered to examine this subject in depth. We agree with Zabalza et al that more studies in this area are warranted and would add that these studies, prospective and otherwise, need to be sufficiently powered to meaningfully investigate the intraoperative approach between second- and third-year residents. It is our hope that, through exploration of this issue, residency programs will begin to actively question the convention of waiting until the third year before allowing resident-performed phacoemulsification. Resident Cataract SurgeryOphthalmologyVol. 119Issue 2PreviewWe are writing regarding the recent report by Woodfield et al1 about resident cataract surgery complication rates. We definitely agree that it provides useful information that we might apply to our Ophthalmology Residency Training Program. However, it is also true that the results provided in this article are rather controversial. Full-Text PDF