April 2017

“Refuse to be average. Let your heart soar as high as it will.”

Aiden Wilson Tozer

TASK AT HAND: This week I’m thinking about “regressing to the mean”. You hear this a lot in sports, economics, and human performance. In statistics, regression to the mean describes that over time, extreme measurements will be closer to the average for the group (because measurements cluster about the average). In other words, outliers will tend to be closer to the average as more measurements are made.

For example, a baseball player may hit 2 home runs in one game but, over the season, they will perform closer to their overall batting average. In another example, the stock market may have a positive or negative run in the short term but, over any appreciable time frame, it will perform closer to the average lifetime behavior. Basically, “regression to the mean” describes that things tend to even out over time.

“Regression to the mean describes that things tend to even out over time.”

How can we use regression to the mean to improve our decision making and strategy?

What can we learn from this statistical phenomenon to illuminate our performance?

First, we need to identify that, on average, we are all average for most of our skills. Everyone cannot be the top 1% or 10% – statistically this is impossible. I find it a callous fallacy when we endow the belief that we can all be the best or fastest at all tasks. This is not possible because, over time, we will gravitate towards the average for that task in question.

But, this need not be a self-fulfilling prophecy because statistical regression toward the mean is not a causal phenomenon. Regression to the mean does not describe cause and effect. Instead, regression to the mean is based on random error about an average. The next bit is important: your performance is not destined to be average. Your performance can be an outlier. It can be bold and a superlative extension of the objective you are trying to achieve.

I have found that, self-awareness into how we are performing, can bring to light where “our average” lies for certain tasks and proficiencies. As we learn our “average”, we can work to incrementally improve them. Realizing that regression to the mean is not an eventuality opens the door to reflection and progress. Ultimately, it starts to differentiate our performance on tasks from ourselves as individuals. Our performance may sometimes be average, but our ability to learn from it will never just be average.


MEDICINE & MACULA: Check out one of our recent publications, Proliferative Vitreoretinopathy (PVR) Update: Current Surgical Techniques and Emerging Medical Management (Robin K Kuriakose, Kunyong Xu, Eric K Chin & David RP Almeida) published in the Journal of VitreoRetinal Diseases (April 2017).

You can find the study here.

In this detailed review, we provide an update on current surgical techniques and emerging medical management in proliferative vitreoretinopathy (PVR). PVR is the number one cause of failed retinal detachment repair and still a relatively unexplained phenomenon. We, along with Citrus Therapeutics, are working hard to find treatments for this challenging disease.


GRATIS: “The average adult laughs 15 times a day; the average child, more than 400 times.” Martha Beck


My best to you,

David Almeida


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“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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