“Always take your job seriously, never yourself.” – General Fox Connor would routinely tell this to his young protégé, Dwight D Eisenhower


TASK AT HAND: This week I’m thinking about decisions and discernment; that is, how to best judge the decisions we make. Recently, The Ophthalmologist published one of my articles on the framework of Decision Diagnosis and how to apply the PACT strategy for effective decision making.

PACT refers to Practice, Assess, Collect and Triage. If you are struggling with decision making, then Decision Diagnosis can help you make a PACT as follows:

Practice: Practice makes permanence. Practice with purpose and passion and it will transform and allow for positive development. You need to break the cycle of mindless practice and instill passion and purpose in the skills you hope to hone.

Assess the problem: Identify the character of the conflict. Ask open-ended questions like who, what, when, where and why? Without knowing the character of the problem, the best decision may elude you.

Collect information: Who are the people, places and things relevant to your decision?

Triage: Define how much time you have to make the decision in question. Triage your decision to assess if you need to resolve it right away or if it can be dealt with as a lower priority?

This framework should illuminate key characteristics of decisions and help you discern the best strategy to effectively reach your desired outcomes. Most importantly, clarity in discernment will allow to avoid decision malaise and guide you to fruitful and focused decisions!

I want to express sincere thanks to The Ophthalmologist for publishing my article in the February 2018 issue. You can find the article here.


MEDICINE & MACULA: Also in the February 2018 issue of The Ophthalmologist, you will find the article, When primary scleral buckling should be considered – and how to succeed by Alexander Ringeisen, Ed Ryan and myself.

We go over why scleral buckling is still the treatment of choice for certain retinal detachments and which patients are the best candidates for a primary scleral buckle. The article is aimed at ophthalmology residents and vitreoretinal fellows and provides an overview of when primary buckling should be considered. Furthermore, it provides guidance on which techniques will help success rates, as well as when to avoid a primary buckle.

Here is a patient who presented with a traumatic dialysis and underwent primary scleral buckling for repair. Postoperative fundus image shows the retina reattached with excellent visual outcomes.

You can check out the entire publication here.


GRATIS:  Many thanks again to The Ophthalmologist for showing our work in the February 2018 issue! Check out for a wide array of fantastic content.


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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