In his editorial, Dr O'Day1 calls our attention to what may be a "surgical industrial complex," consisting of equipment manufacturers, publishers of glossy tabloids, and surgeons who have a high volume of cataract surgery and work outside the hospital environment. He suggests that this body is responsible for an ever developing arena of surgical devices and methods concerned with cataract surgery. He cautions us to recognize that the frequent technological changes in smallincision cataract surgery may be costly and that these new methods have not been established by evidence in the refereed literature as truly superior to prior techniques. He asserts that the routine use of phacoemulsification may be neither advantageous nor cost-effective and refers us to an article in the same issue of the Archives by Schein and coworkers2 that reports the surgical preferences of randomly surveyed members of the American Academy of Ophthalmology regarding cataract surgery