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The Editorial was written to underscore the dilemma experienced by all cataract surgeons: how to choose among the ever increasing cascade of technical changes, large and small, to enhance surgical results without exposing patients to risk. To interpret it as a Custerlike stand for large incision extracapsular surgery is to miss the point completely.Dr Masket's thoughtful comments about the selection of appropriate outcome measures focus on 1 of the 2 key deficiencies in the current cataract literature, the other being the lack of sufficient scientific rigor in reported studies. It was this failure to meet basic accepted scientific standards rather than the imposition of "rigid criteria" that led to the exclusion of so many publications during the cataract guideline literature review.I agree completely that an absence of supportive literature does not necessarily equate with a lack of benefit. The problem for the surgeon is where to