Cataract surgery really hard

[Bboy323]

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I have been out for a few years now and have been doing cataract surgery.. Usually everything goes fine, but I still have a broken capsule every few months and it always is a crushing and demoRalizing expeRience. Recently I have been thinking of ways to either somehow improve my skills, stop doing cataracts, or get out of ophtho altogether. I just feel like if I don't master cataract surgery I will be a total failure as an ophthalmologist. I dunno what to do , any advice? Thanks

 

[Mirror Form]

I have been out for a few years now and have been doing cataract surgery.. Usually everything goes fine, but I still have a broken capsule every few months and it always is a crushing and demoRalizing expeRience. Recently I have been thinking of ways to either somehow improve my skills, stop doing cataracts, or get out of ophtho altogether. I just feel like if I don't master cataract surgery I will be a total failure as an ophthalmologist. I dunno what to do , any advice? Thanks

Yeah, cataract surgery is hard and everybody has complications. You can't expect to be as good as the guy who's done 10,000 after only doing a few hundred cases. It's depressing when you have complications but that's part of being a surgeon. There are a decent number of ophthalmologists going medical these days, so that's always an option I guess. Or you could do medical retina.

But as long as you're not having really serious complications then your best bet is to probably just keep honing your cataract skills.

 

[guttata]

I know it is difficult to not beat yourself up over these things, but every surgeon will have complications. You need to manage and learn from them. When do the ruptures occur? Is it during phaco or I+A? If it is during phaco, consider another technique. If it is during I+A, consider using a silicone tip.

Remember that patients will usually have excellent outcomes if you manage them properly. If you treat patients well, they will understand complications happen.

Most surgeons hone their skills for many years after residency. You can (1) stick with it (see above) (2) do medical ophthalmology (3) apply for fellowship (uveitis, medical retina, neuro) (4) wait for femtosecond or (5) quit.

 

[LightBox]

It depends on how many cataract surgeries you have done. I think that anyone who has done less than 1000 cataracts is still on the learning curve where you have room for improvement. It also depends on how many cataracts you do a week. It is much easier to become facile with the procedure if you are doing at least 10 a week, and thus can get in a "rhythm." If you are doing a phaco here and there, you won't ever get that good because you will always be stressing about that "one case" coming up. Once you stop worrying about every patient, you'll be much less nervous and likely will be a better surgeon. I used to obsess about every single patient's risk factor for surgery..."this patient has a shallow a/c....this patient has only a 5 mm pupil...this patient was a squeezer in clinic!" It got to the point where I was psyching myself out. I think part of this is how crazy obsessive some academic eye docs are when they train their residents. I remember that one of my attendings would be super-critical about me making a SIDEPORT incision! For the love-of-god, it is just a sideport incision. But frivolous criticism like that would make me more nervous for the rest of the case. But now, I don't obsess and just let my muscle memory take over.

Lastly, I think that one of the best things you can do is to observe someone who is much better than you operate, and to also have this person watch you operate and give you tips. e.g. if you are having trouble with nucleus disassembly, watch how your friend does it.

 

[johnbl]

i am a 59 yr old high volume cataract surgeon . I came to the site tonight because my daughter bombed her mcats for the fourth time despite 2 prep courses and lots of studying...3.8 gpa out of UVA with great recs and extracurriculars...rejected last yr and reapplying again...it is very painful to see this happen. I came to look at do and carribean med schools for her..anyways i wandered to the ophth section there is a point where you will start to feel more comfortable with phaco/ia..It may be 100...it may be 1000 cases...Go and see someone like myself who has simplified the surgery in steps and approach..send someone like myself some videos of your surgery. Analyze where the problems are occuring ..If you do this..I guarantee you will get better..I am a better phaco surgeon than I was 5 yrs ago.. I had a 3mm pupil case in a pt under topical with the guy moving more than I would have wanted..yes a bit nerve racking but went well...you need to have confidence and think you are good also..