An interview with Reena Garg, MD, Glaucoma Surgeon, Visionary Eye Doctors, Washington, DC.
As surgical options continue to expand across ophthalmology, today’s operating room is more dynamic and more complex than ever before. While innovation has created new opportunities, it has also introduced additional decision points, placing a premium on efficiency, consistency, and predictability in procedural execution.
In this interview, Dr. Reena Garg shares how she approaches surgical decisionmaking in the modern OR. Her perspective emphasizes thoughtful standardization, strong fundamentals and confidence under pressure; principles that resonate not only with subspecialists, but with cataract and refractive surgeons navigating increasingly complex procedural environments. She also discusses how tools designed around surgeon control can support a more consistent and confident experience in the OR.
How do evolving tools and technologies influence your surgical decisionmaking today?
Dr. Garg: One of the exciting aspects of ophthalmic surgery is how quickly the field continues to evolve. New tools and techniques are constantly emerging, which creates opportunity, but it also requires discipline.
For me, the key question is whether a tool truly adds value to my workflow. More options don’t automatically translate into better surgery. New technology needs to demonstrate reliability and consistency. It should reduce variability, not introduce more of it. I’m particularly mindful of whether a tool gives me control in the moment, rather than forcing me to adapt my technique to the device.
Ultimately, innovation should simplify decision-making, not complicate it.
As procedural options continue to expand, how do you simplify choices for yourself and for patients?
Dr. Garg: In ophthalmology there is often a desire to make decision-making algorithmic because predictability is reassuring. While such frameworks can be helpful, surgery doesn’t always follow a script, and patients don’t always fit neatly into predefined categories.
I simplify decisions by returning to a basic litmus test: Is it safe? Is it reliable? And does it meaningfully support my procedural goals?
If something doesn’t meet those criteria, it’s easy to rule out. If it does, then I look at the broader context, the patient’s history, prior interventions, and how the approach fits into my established workflow. Recently I had the opportunity to evaluate the VIA360™ Surgical System and was able to run it through this litmus test. Based on my experience with products from a company I know well, safety and reliability were already established for me. The deciding factor was whether it meaningfully supported my procedural goals while fitting seamlessly into how I already operate in the OR and that was where VIA360™️ aligned well with my approach.
How do you define efficiency in surgery, and how does it shape your workflow in the OR?
Dr. Garg: Efficiency is often mistaken for speed, but for me, efficiency is really about standardization and predictability.
True efficiency comes from creating workflows that are repeatable and intuitive. I aim to keep my setup consistent; my steps deliberate and my decision points clear. That reduces cognitive burden, not only for me, but for the entire OR team.
When new tools are introduced, I want to understand how they fit into the existing framework and whether they simplify the process. With the VIA360™ Surgical System, design elements such as single-entry access, helped me to avoid device rotation, and minimize the number of times I had to go in and out of the eye. This has made a meaningful difference in how smoothly the procedure runs.
When you think about predictability what does that mean in day-to-day practice?
Dr. Garg: Predictability translates to preparation and control. There are always elements in surgery we can’t control: tissue behavior, anatomic variation, or unexpected events. What we can control is our preparation and the tools we choose to use.
Spending time refining techniques and understanding how tools behave allows you to respond effectively when something unexpected occurs. That preparation helps maintain procedural flow, even when conditions change.
For example, I’ve incorporated the VIA360™ Surgical System into my workflow because it allows active, ondemand viscoelastic delivery when I choose, rather than relying on passive injection. The ability to deliver viscoelastic intentionally, including in multiple directions without rotating the device, supports consistency in how I approach each case.
In my experience, predictability is the result of efficiency, preparation, experience and thoughtful tool selection working together.
When time is of the essence and a case doesn’t follow the expected script, how do you stay confident and avoid second-guessing?
Dr. Garg: I allow myself to pause, even if it’s just a few seconds. I step back and ask myself, “Where am I in the procedure? What is my objective? What’s the next best step?”
Those brief pauses are important. They allow me to reset and refocus. Having tools that respond predictably to input, without requiring additional adjustments, helps maintain procedural flow in those moments.
Returning to what I know well helps me move forward with confidence rather than reacting impulsively.
How do less complex, implant-free approaches fit into your thinking when streamlining OR workflow?
Dr. Garg: In surgery, simplicity is often an advantage. There’s a saying that “the enemy of good is better,” and I think that’s very relevant in the OR.
When planning a procedure, I focus on the long-term perspective and procedural intent. From there, I evaluate tools based on how well they integrate into my workflow. When multiple approaches align with my goals, I often gravitate toward implant-free options that preserve flexibility without adding unnecessary complexity.
In the case of VIA360™️, it offered an implant-free approach that allowed for controlled viscoelastic delivery through a single-entry point, while fitting naturally into how I already work in the OR. That balance, maintaining simplicity while supporting surgeon control, is important to me.
For surgeons, having options that integrate seamlessly into established workflows, without adding cognitive or logistical burden, can be incredibly valuable.
Looking Ahead
As the modern OR continues to evolve, decision-making has become just as important as technical skill. For surgeons like Dr. Garg, consistency, efficiency, and control form the foundation of confident procedural execution, regardless of how many new options emerge.
In the next article in this series, we’ll explore how surgeons design OR workflows that support efficiency and consistency, and how thoughtful standardization can reduce variability across cases and teams.
This article is sponsored by New World Medical, whose mission is to preserve and enhance vision by delivering innovations to benefit humanity. New World Medical supports surgeons through a portfolio of surgical solutions designed to integrate into modern OR workflows, including the VIA360™ Surgical System, which features active, on-demand viscoelastic delivery, and single-entry design to support procedural efficiency and consistency.
