Reply to Comment “Governing Self-Directed Adoption of New Ophthalmic Procedures”

Dear Editor, We appreciate Dr. Henry Bair’s interest in our article, “Surgical learning: A survey to evaluate how ophthalmologists learn new surgical techniques”.1 His remarks highlight several important considerations regarding the contemporary adoption of surgical innovations. He suggests that our primary outcome measure, the number of new techniques adopted within the preceding 5 years, may conflate incremental modifications with substantive procedural innovations. We note that the survey instructions specifically directed respondents to report only techniques, for which a significant component or the entirety of the procedure was new, and to exclude minor refinements to existing techniques. This approach was chosen to minimize the recall bias when ensuring that the outcome measure reflected meaningful procedural change rather than routine adjustments to established practice. His emphasis on governance and structured learning pathways is also noted. These themes align closely with points articulated in our discussion. We highlighted the variability and limitations of unmoderated online surgical content, the absence of opportunities for expert feedback, the potential for misinterpretation of procedural steps, and the uncertain applicability of such material to Australasian practice. We further identified an opportunity for surgical colleges to develop high-quality, peer-reviewed educational resources and recognized the established role of simulation-based training, when acknowledging its variable accessibility across the region. His suggestions regarding competency-based pathways and credentialing structures may be viewed as an extension of these considerations. We agree that further research characterizing the complexity, evidentiary support, and patient-level implications of specific techniques would be a valuable next step and could inform the development of governance frameworks. We thank him for contributing to the ongoing discussion regarding surgical learning and innovation. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.