“Cogito ergo sum.”

“I think, therefore I am.”

This is the proposition most commonly quoted for the French philosopher Rene Descartes.

However, when you look at his text, Discourse on the Method, it actually reads:


“Dubito, ergo cogito, ergo sum.”

“I doubt, therefore I think, therefore I am.”


TASK AT HAND: This week I’m thinking about doubt and apathy. Doubt, in my opinion, is a vital force in the quest for understanding. Without doubt, the search for knowledge can become complacent and dull.

“Without doubt, the search for knowledge can become complacent and dull.”

For Descartes, the act of doubting one’s own existence served as a basic proof of the reality of one’s own mind. This doubt, allowed for thinking beasts to realize fundamentals. Today’s Sunday Surgical Scrub is not about Descartes but it serves our discussion on doubt well.

Doubt is an extension of the existence of the individual. It is this ability – the ability to doubt – that can affirm one’s existence and their associated system of beliefs and ethics. In modern living, with all its virtual connections and influences, it is necessary to doubt regularly so that one can arrive at key aspects of character in multiple scenarios.

In the modern context, there exists an endless sea of statements, many of which are derived neither from data or fact. This is where doubt can save you! Doubt what you see on social media, doubt what you hear on television, doubt what you read in the news; doubt your teacher and preacher alike. Doubt so that you may come to understand.

“Doubt so that you may come to understand.”

What role does apathy play? Apathy is defined as a lack of interest, enthusiasm, or concern. In medicine, it can be a diagnostic clue to psychiatric disease. However, I believe the strength to be apathetic – to garner little concern for trivialities can be a boon of strength. Consider the human of today as an over-connected organism and you realize that – to effectively think for yourself – doubt and apathy are cornerstones to living comfortably in your own skin.


MEDICINE & MACULA: Many thanks to Mpls.St.Paul Magazine for selecting me as one of their Top Doctors Rising Stars in the April 2017 issue. This is awarded to physicians selected through a peer-nomination process. You can find the list here.

GRATIS: Descartes published The Discourse on the Method in 1637. It was originally titled: Discourse on the Method of Rightly Conducting One’s Reason and of Seeking Truth in the Sciences. I like the long title!


My best to you,

David Almeida


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“Learn about others and the world around you but, most of all, be a lifelong learner of who you are and how you are changing.”

TASK AT HAND: This week I’m thinking about what it means to be a lifelong learner. Traditionally, we consider this in the context of learning new skills or the increased proficiency of our current skill set. This is beneficial for the objectives of improving productivity and efficiency.

But, more importantly – and often neglected – is the commitment to the evolution of learning about who we are and how we are changing. Study after study shows that people generally underestimate the extent of future personality growth. Researchers call this phenomenon “the end of history illusion” in that we tend to assume that our growth ends as we get older. (You can find a nice summary of recent studies here.)

“More importantly – and often neglected – is the commitment to the evolution of learning about who we are and how we are changing.”

This “end of history” illusion creates a possible hurdle in that we stop learning of who we are and how we are changing. This occurs because we think we have stopped changing, not realizing that, like the empty pages of a book yet to be written, our personalities have ongoing potential for growth. This potential for growth is often materialized with or without our knowledge or consent.

“The ‘end of history’ illusion occurs when people underestimate the extent of future personality growth.”

In this sentiment, today’s Sunday Surgical Scrub has a simple call to action: be a lifelong learner of you! Dedicate time and resources to the reflection of who are now and who you are becoming tomorrow. This will strengthen you, support your future strategies and goals, and be a boon to the ones around you.


MEDICINE & MACULA: A very sincere thanks for making The Ophthalmologist 2017 Power List! I am humbled to be considered one of the top 50 rising stars in ophthalmology. Moreover, I am grateful to be in the company of such wonderful and gifted colleagues!

You can find the list here.


My profile is here.


GRATIS: “ ‘Thank you’ is the best prayer that anyone could say. I say that one a lot.” -Alice Walker


My best to you,

David Almeida


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“Begin the work. Forget the phantom of failure. Just start!”


TASK AT HAND: This week I’m thinking about the power of starting something. For those that visit here often, you know of my contempt for procrastination. My distaste for the paralysis of inaction. The inability to overcome inertia limits positive movement and meaningful strategy.

How do you keep this from holding you or your firm back?


Begin the work. Forget the phantom of failure. Simply start. Don’t worry about how hard you will have to strive. Don’t catalogue the reasons why it won’t work. Don’t fret over details and dire straits. Don’t ingratiate with impotence and ineptitude. Be it a moment or movement, start something. Whether a decision or an affirmation, by simply starting, you have overcome dread, delay and procrastination.

“By simply starting, you have overcome dread, delay and procrastination.”

When success finds you, the wave is easy to ride. When strategic moves are clicking, the puzzle fills in an orderly fashion and it seems all too easy. But, when you hit walls, when the pieces don’t fit, when your plans fail to crystallize; this when the ability to start something must be called upon.

Pandora, the online music streaming site, was rejected by over 300 venture capitalists and spent over two years of its early life broke, without cash. Nonetheless, Pandora utilized the resources available to create a basic platform. It started a tangible access point towards the goal of its creators. Online music streaming, like other competitive spaces, ensures multitudes of roadblocks and challenges and it will require the continual call of this skill.

Let’s take a job seeker as another example. How many rejections will you take? How many “No” and “I’ll pass” will you accept before you give up? How many times will you fail before you will do not risk failure again?

There is no number to contemplate, just start! Not in the fashion of Sisyphus, where the task was stereotyped and repeated in an endless loop. Instead, start anew, be willing, be flexible to learn from previous examples. This willingness to start anew, to pivot, to find a path of positive movement serves individuals and companies alike with the vector of acceleration where many seem content to circle at some average speed. The only requirement is that you start.


MEDICINE & MACULA: Fantastic to be part of the faculty at the Vit-Buckle Society V meeting in Las Vegas this past weekend (6-8 April 2017). Grateful for the discussion, learning new techniques that can best help our patients, and catching up with friends and colleagues!

I presented a talk on proliferative vitreoretinopathy (PVR), including pearls and techniques, for this challenging group of patients. Patients who are current or former smokers are significantly more likely to have PVR formation after retinal detachment repair.


GRATIS: Go ahead, start something!


My best to you,

David Almeida


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“The cure for the calamity of inaction?

A pact to make a decision with passion and purpose!”

TASK AT HAND: This week I’m thinking about decisions and indecision. Over the last few weeks, I have been repeatedly asked, “why did you write a book about decisions?” I pontificate, and answer, there is a major difference between pondering and procrastinating…

We have become accustomed to endless information, right there at our fingertips, to supplant the need for critical thinking. Through the endless notifications, messages and distractions, the data deluge has reduced our attention span and, with it, reduced our capacity for effective decision making. We procrastinate and put off for tomorrow what we should be doing today. The resultant is an overwhelming vector of negativity on our ability to solve the problems we face. Whether we like it or not, we must all make decisions. Through fear and faction, we must decide or risk time, opportunity, and fulfillment.

So, how do you come up with a strategy that will help you make better decisions? That’s the impetus of why I wrote, Decision Diagnosis: Seven Antidotes to Decision Procrastination (both paperback and Kindle versions available here). In it, I present an efficient and expedited strategy for successful outcomes regardless of the decision in question.

What’s the main takeaway?

If you are struggling making decisions, it’s time for you to make a PACT. Here is a quick summary of PACT:

1.     PRACTICE: Practice makes permanence. Practice, with purpose and passion, transforms.

2.    ASSESSMENT: Assess the problem: Identify the character of the conflict. Ask open-ended questions, “who”, “what”, “when”, “where” and “why” to uncover the character of the decision.

3.     COLLECT: Collect information on who are the people, what are the places and things, relevant to your decision. Think like a physician and collect the pertinent positives and negatives that describe your question.

4.     TIMING: Define how much time you must make the decision in question. Immediately triage your decision – do I need to resolve this right now, or can I do it later?

By applying this PACT framework, you will dramatically improve your decision making ability and the ability to seek the answers that resonate with your goals and objectives.


MEDICINE & MACULA: Thank you RETINA TODAY for showcasing our novel technique on retinal embolectomy in the current issue, entitled: Retinal Embolectomy: Why, When, How? (David R.P. Almeida, Eric K. Chin & Vinit B. Mahajan).

We describe surgical embolectomy as a viable technique for patients with acute fovea-threatening arterial occlusions without a patent cilioretinal artery. Our goal, with this technique, is to push forward the potential for innovation in vitreoretinal surgery. We are thankful for the interest and discussion this has generated.

You can find the article here.


GRATIS: “No compromise with the main purpose, no peace till victory, no pact with unrepentant wrong.” -Winston Churchill


My best to you,

David Almeida


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“Routine, in an intelligent man, is a sign of ambition.”

–WH Auden


TASK AT HAND: This week I’m thinking about routines. Stereotypical movements, rhythmical thoughts, and choreographed actions that we employ without second thought. Sometimes blamed for lacking in creativity for the sake of productivity, routines get an unfair share of criticism. Properly employed, routines can successfully support our strategies and objectives. Below are 3 key benefits of routines.

“Properly employed, routines can successfully support our strategies and objectives.”

1. Routines minimize cognitive burden. I have talked about cognitive burden before (Sunday Surgical Scrub from 12 June 2016, you can find the original post here). Cognitive load refers to the total amount of mental effort being used in the working memory. Cognitive burden can be thought of as an excess load on our mental effort. You can minimize undue burden by employing routines. For example, email has immense potential to overwhelm our cognitive load; however, by developing a routine to manage your messages, you can efficiently meet priorities without becoming a slave to your inbox.

2. You are what you repeatedly do. Your routines speak volumes about who you are. Routines describe what you commonly do. When looking for change, don’t start with a long shot. Change a routine and build a process to achieve your goal. Are you trying to improve your physical strength? I would forego the goal to bench a new Olympic record. Instead, create a routine where, for example, you incorporate weight training on certain gym days. Simple modifications to routines can transform major behaviors.

“Simple modifications to routines can transform major behaviors.”

3. Routine = Consistency. Having a routine can improve the consistent performance of physical and mental tasks. For example, a basketball player will bounce the ball several times before attempting a free throw. He or she uses this routine as a method of preparation to improve the chances of making the basket. When I’m performing scleral buckle procedures for retinal detachments, I always re-grasp the needle before making a scleral pass. This simple routine reminds me to focus on the exact depth I want to place the needle: too shallow, and the suture will not hold but, too deep, and I will perforate the eye. Both are negative scenarios I need to avoid. This simple routine helps me achieve consistent placement of the suture.

Optimize your routines as a means of process improvement. Life will throw you distractions like travel and sickness with the potential of upending your abilities. Use routines to remain focused on your core ambitions.


MEDICINE & MACULA: Throwback to 2012 when we published our case, Ophthalmic artery occlusion secondary to fat emboli after cosmetic nasal injection of autologous fat. This was published in the journal RETINA (you can find the study here) and is the case of a patient who lost all vision after undergoing cosmetic nasal fat injection. The striking color fundus photograph shows fat emboli that occluded the ophthalmic artery.

A stark reminder that all procedures, even benign elective ones, have the potential for profound complication.


GRATIS: “The secret of your future is hidden in your daily routine.” -Mike Murdock


My best to you,

David Almeida


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“From reading too much, and sleeping too little, his brain dried up on him and he lost his judgment.” -Miguel de Cervantes

TASK AT HAND: This week I’m thinking about sleep. An overlooked and neglected component that is vital to our optimal reasoning and performance. Too often we look to the lack of sleep as a badge of honor indicating exemplary endurance. I look back at my years as a researcher, medical student, and on-call intern and how I would consider 30 or 40 hours without sleep a proud achievement. Now, I realize that, in those instances, I failed to care for myself and operated in suboptimal conditions.

We know that sleep restriction and sleep deprivation is linked with the development of diseases like obesity, diabetes, and hypertension. Researchers have shown that severe sleep loss jolts the immune system just as stress does, impairing our ability to properly tackle mental and physical tasks (check out study here). Sleep loss quadruples the risk of stroke (find the study here). Lack of sleep is not a badge of honor; rather, it is a mark of embarrassment reflecting our myopic self-awareness and unwillingness to be our best.

“Lack of sleep is not a badge of honor; rather, it’s a mark of embarrassment reflecting our myopic self-awareness and unwillingness to be our best.”


Today on the Sunday Surgical Scrub, here are three common questions that I have received on sleep recently. Ponder and enjoy!


1. Once in bed, how long should it take me to fall asleep?

This is known as Sleep Onset Latency or Sleep Latency and defined as the length of time that it takes to accomplish the transition from full wakefulness to sleep. If you take less than 5 minutes to fall asleep, you are sleep deprived! The ideal target is between 10 and 15 minutes, which indicates you’re tired enough to sleep but not exhausted as to show signs of daytime sleepiness.

The most important pearl here: once you get to bed, turn off your phone. The never-ending accessibility to the internet and constant messages, notifications, and distractions will disrupt your sleep latency and your subsequent stages of sleep. Your bed should be for sex and sleep. I don’t see the need for a phone here.


2. How much sleep do I actually need?

Most healthy adults need 7 to 9 hours of sleep a night. Although some individuals can function without sleepiness or drowsiness after as little as 6 hours of sleep – known as short sleepers – this represents less than 1% of the population so, chances are, this is not you. Short sleepers are believed to derive this ability from a genetic mutation on the DEC2 gene (check out the study here).

When considering how many hours you need to sleep, I believe there must be a philosophical shift in how you see the objective of sleep. Commonly, we look to how much sleep we need to “get by” or “survive” the next day. Change it up: how much sleep do you need to peak and thrive tomorrow?


3. What’s up with nightmares? What happens when I’m sleeping anyways?

Nightmares are defined as disturbing dreams in which unpleasant visual imagery or emotions wake us up. Contrary to popular belief, fear is not to the main emotion in nightmares; instead, researchers have found that it’s most often feelings of sadness, guilt and confusion (find the study here). Self-reflection, exercise, journaling, meditation are just a few common ways to reconcile the negative emotions that we harbor and can go on to degrade our sleep quality.

This blog post is much too short to describe all the processes and mechanisms that underlie sleep. Further, its unclear exactly why organisms need to sleep. However, it seems that most, if not all, species regularly enter a circadian rest state.


MEDICINE & MACULA: Special mention to an excellent study entitled, Fatigue, Alcohol and Performance Impairment from the journal Nature.


The study looked at sleep loss in terms of equivalent alcohol intoxication. A group of 40 participants were broken up in to two groups: one group was kept awake for 28 hours, simulating pulling an all-nighter, and the other consumed 10-15g of alcohol at 30-minute intervals until their blood alcohol concentration reached 0.10% (legal limit in every state is 0.08%).

Each group was given a performance task that required them to react as quickly as possible to visual cues randomly timed on a computer. After 17 hours of sustained wakefulness, performance was equivalent to a blood alcohol concentration of 0.05%. After 24 hours of sustained wakefulness, performance was equivalent to those with a blood alcohol concentration of 0.10%. According to this study, sleep deprivation is not so much a badge of honor, as an example of public intoxication (study here).


GRATIS: Man is the only mammal that willingly delays sleep. Stop doing it! For your health and engagement, go to sleep!


My best to you,

David Almeida


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“Perspective is Providence.”


What do you see in the picture above?

It is a color photograph of one of my patients, diagnosed with wet macular degeneration, who has suffered a devastating hemorrhage. Her vision is worse than legal blindness and, due to several factors, the prognosis is poor for any vision improvement.

So, what do you see in this picture of pathology?

Do you see a foregone conclusion? A lost cause? A chance for a miracle? Hope in a complicated case? Consequences of a blinding condition?

Do you fight for any gain, at any cost? Or do you accept and move on preferring to first, do no harm?


TASK AT HAND: This week I’m thinking about perspective. Where the painting tells the story, perspective is the frame. Perspective, must be congruent to the painting of houses, to accurately engage the conflict or decision in question. I think of perspective as the ability to see beyond the literal – to read between the lines – and akin to emotional intelligence. Perspective is to see beyond what meets the eyes. Without it, one is tone deaf. Perspective affords you the ability to decipher in real time, rather than in a vacuum.

“Perspective is to see beyond what meets the eyes. Perspective affords you the ability to decipher in real time, rather than in a vacuum.”


As a surgeon, I’m lucky because I get to develop a frank dialogue with my patients so that we can decide, through informed and shared decision making, on a path to purse together. I provide my professional opinion – but ultimately – we decide together. My perspective in these situations combines a mix of the unique patient before me and the knowledge, experience, and instinct within me. I must never disregard this perspective.

For the decisions in our lives, many of the times, we are not so lucky as to have a second vantage point on decision making. This is one of the reasons why fallacies and bias are so troubling and can cause much of misguided strategy. As we bounce possibilities around, they can become extricated from reality and adorned with bias.

Now, what does providence have to do with any of this?

Providence can be defined as protective care from a higher power such as nature, spiritual forces or religious deities. But, I use it here as defining the timely preparation for future eventualities. Providence, to be prepared for the future, can be found in perspective. In other words, to have perspective and insight, provides preparation for what you may encounter in the unknown path in front of you. For all the apparitions of darkness, joy, pain, success, and failure that you may encounter, find providence in perspective. Use perspective for comprehension. Let your execution be guided by providence.

“Providence, to be prepared for the future, can be found in perspective. Use perspective for comprehension. Let your execution be guided by providence.”


MEDICINE & MACULA: If you haven’t had a chance, check out my new book, Decision Diagnosis: Seven Antidotes to Decision Procrastination. For those who have already gotten their copies, sincere thanks for your interest and for making it an Amazon best seller in multiple categories and countries!

Both paperback and Kindle versions are available here.

GRATIS: “The only real voyage of discovery consists not in seeking new landscapes but in having new eyes.” -Marcel Proust


My best to you,

David Almeida


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“Creativity, in an unproductive form, may emit a flash in the pan, but rarely creates enough light to sustain the night.”


TASK AT HAND: This week I’m thinking about productivity versus creativity. Productivity – how we think – can be thought of as the grammar or syntax of a sentence. Creativity – what we think – are the words, concepts and emotions in that sentence. I think of productivity as the order and arrangement of a composition whereas creativity is the unique melody. While productivity tends to have basis in ordered and logical processes, creativity can be borne out of entropy and randomness.

“Productivity is the order and arrangement of a composition.

Creativity is the unique melody.”


Linear thinking; for example, events separated by time, follows a predictable pattern of organization and can be connected without much labor. On the other hand, the connection of multi-dimensional coordinates usually requires creativity to consolidate disparate variables. Creativity can provide wonderful and novel insights into problems and phenomenon but, the crux is that creativity is not enough for successful strategy. At some point, creative findings need to be distilled into elements of capable comprehension for effective decision making. In summary: being creative is not enough! Much talent is wasted and, we all know examples, where lack of work ethic undermines the creative process.

“At some point, creative findings need to be distilled into elements of capable comprehension.”

Why discuss these two concepts here on this week’s Sunday Surgical Scrub? Over the last few weeks, I have received emails and questions on how to enrich one’s creativity. Personally, few wonders are as rewarding as the creative process; however, often, creativity, or a lack thereof, is not the problem. The more commonly encountered issue lies in deficiencies in bringing that original concept – what you thought – into a thesis that can be evoked and understood.

I need to emphasize that the call to action here is not for more productive individuals at a cost of creativity. Rather, seek a state of wholeness where both the synthesis and organization of new thoughts and ideas coexist. Find congruency in their relationship.

“Seek a state of wholeness where both the synthesis and organization of new ideas coexist.”

Next time you are pondering problems or reflecting on ramifications, break down the elements of your decisions into the aspects of productivity (how you think) and creativity (what you think). This will give you valuable insight into the overall process. You will be surprised at your creativity, and you will appreciate the process for decoding it.


MEDICINE & MACULA:  Many thanks to Scott Krzywonos, Editor-in-Chief of New Retina MD and producer of the New Retina Radio podcast.

I was on the latest New Retina Radio Podcast. Check out Episode 4, PhD, MBA, JD, MS: Alphabet Soup where we discuss how multiple degrees, beyond the Medical Doctor, enrich the role of the physician and the subspecialty of vitreoretinal surgery.

You can find the episode here.


GRATIS: Both productivity and creativity are concepts that improve with journaling. Write down 1-3 new ideas each day. Do this at a time of day when you are alert and awake (not as a checklist before bed). Warning: they will be terrible at first, but this is ok. Like working a muscle, you need to build up strength, endurance, and precision in the execution of creative thought. Next, write down one problem or process that hinders your productivity (look out for the repeated theme of procrastination). The latter will allow you to identify areas that bleed productivity from your life. Finally, periodically reflect on your points to strengthen your creativity and intellectual prowess. Not uncommonly, you will be pleasantly surprised to find creative solutions to productivity problems.


My best to you,

David Almeida


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“Do not be sunk by the weight of history and do not let inertia impede your improvement.”


TASK AT HAND: This week I’m thinking about two stumbling blocks that can insidiously creep into our perceptions and influence our strategies.

1. The weight of history. The weight of history is the concept that our personal and collective historical baggage can be so heavy that it limits our progress. This can strain relationships and hinder decision making.

Now, it is imperative that you live with the correct – i.e., true – facts and conclusions from your history. However, it does not mean you must be weighed down by them. History is an ocean of knowledge, but it can also drown you. If you shackle yourself to the portrait of who you were yesterday, you may bind yourself to painting the same picture again today.

“If you shackle yourself to the portrait of who you were yesterday, you may bind yourself to painting the same picture again today.”

I want you to let go of this weight! How? Find an action or outcome from the past that you felt delivered underwhelming results. Look for the root cause; for example, a tendency to rush decisions. Now, find a tentative solution; like being cognizant of the time available for each decision. Then, institute a change as a means of unburdening yourself of a negative historical weight.


2. Law of inertia. This concept is from Newton’s First Law of Motion which reads:

“An object at rest stays at rest and an object in motion stays in motion with the same speed and in the same direction unless acted upon by an unbalanced force.” Newton’s First Law of Motion

I want to surmise this law into a simple statement: “objects tend to do what they do”.

What’s the relevance for us? Where the weight of history limits our progress, the inertia in our lives – the stereotypical rhythms of our actions and strategies – can keep us from findings new directions to grow, learn, and discover.

How do you curate the change to overcome inertia? Newton answers this for us: “unless acted by an unbalanced force”. Find an unbalanced force – spontaneity, travel, a rewarding relationship – and invest time and energy in it to overcome the inertia and resistance blowing against you.


MEDICINE & MACULA: Check out our newest publication, Efficacy of the Intravitreal Sustained-Release Dexamethasone Implant for Diabetic Macular Edema Refractory to Anti-Vascular Endothelial Growth Factor Therapy: Meta-Analysis and Clinical Implications (Khan, Kuriakose, Khan, Chin & Almeida) published in Ophthalmic Surgery, Lasers and Imaging Retina (February 2017, Volume 48, Issue 2, pages 160-166, DOI: 10.3928/23258160-20170130-10).

In this meta-analysis, we examined a total of 3,859 patients among 15 studies and found that treatment with Ozurdex is associated with significant mean improvement in visual acuity in patients with diabetic macular edema who have a sub-optimal response to anti-vascular endothelial growth factor therapy. This is further support to a multimodality approach to treating diabetic macular edema.

You can find the study here.

GRATIS: “The reason men oppose progress is not that they hate progress, but that they love inertia.” -Elbert Hubbard


My best to you,

David Almeida


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“Panic causes tunnel vision. Calm acceptance of danger allows us to more easily assess the situation and see the options.” -Simon Sinek


TASK AT HAND: This week I’m thinking about the pitfall of cognitive tunneling. Cognitive tunneling, also known as cognitive capture, is an inattentional blindness phenomenon where one becomes hyper-focused on some variable other than the present environment. When this occurs, as the old axiom states, you “can’t see the forest for the trees”; or in other words, you become obsessed in some sentence that you lose perspective of the story.

“Cognitive tunneling is an inattentional blindness phenomenon where one can’t see the forest for the trees.”

When cognitive tunneling occurs, the individual may become lost in internal thought or instrumentation and lose focus on the present action or environment. An example would be a pilot focused on an altimeter rather than the runway ahead. More commonly, we tend to become entrenched in inner negative thought rather than executing effective strategies for the conflicts we face in our lives.

Inattentional blindness is primarily caused by our unconscious minds, particularly when we are overwhelmed with information or options, fatigued, inebriated or panicked (Caroline Beaton, Millennial Cognitive Tunnel Syndrome: Why We Miss The Solutions To Our Career Crises, Forbes July 2016). Realizing that our unconscious minds aren’t always the best at determining what’s important, cognitive tunneling helps explains why we tend to react to failures in counterproductive ways. Instead of remaining focused on the conflict, we lose awareness and move farther away from resolving the issue.

As mentioned above, under stress, this cognitive capture is exacerbated into the error of tunnel vision where the range of cue utilization is reduced (Dirkin GR, Cognitive tunneling: use of visual information under stress, Percept Mot Skills 1983;56(1):191-8). Simply put, tunnel vision limits our ability to process peripheral information because we are over-committed to some central issue.

“Under stress, this cognitive capture is exacerbated into the error of tunnel vision.”

Why is this important?

The crux here is awareness! You are at your best with maximal awareness for the task at hand, but also by being cognizant of the variables that influence it. Awareness is akin to context and, minimizing cognitive tunneling, aids you in the processing of relevant information. One step further, improved contextual awareness allows you to filter out the relevant from the irrelevant which minimizes your chances of becoming trapped by unimportant details.

“Awareness is akin to context and, minimizing cognitive tunneling, aids you in the processing of relevant information.”


MEDICINE & MACULA: Thanks again for all the interest in my new book, Decision Diagnosis: Seven Antidotes to Decision Procrastination, and for making it an Amazon best seller in multiple categories and countries!

Both paperback and Kindle versions are now available here.

GRATIS: “Stress makes us prone to tunnel vision, less likely to take in the information we need. Anxiety makes us more risk-averse than we would be regularly and more deferential.” -Noreena Hertz


My best to you,

David Almeida


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