An 80-year-old man with severe kyphosis and visually significant cataracts in both eyes came to us for care. He had been scheduled for cataract surgery elsewhere, but his surgery was cancelled in the operating room when he could not be positioned adequately beneath the operating microscope. As he sat in a chair in our examining room, he was only able to elevate his head to a position 30 degrees below the horizontal. His cataract surgery was performed safely and effectively by padding the operating table with 14 pillows. Eleven pillows were placed under his buttocks and legs and 3 pillows beneath his head and neck. The operating table was also positioned in maximum reverse Trendelenburg to obtain a good red reflex.