is ophthalmic surgery more difficult than other surgeries

[bertino]

does it require greater psycho motor control and hand to eye coordination than other surgeries?

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[hurdlepup]

Yes


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[MstaKing10]

Yes


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[dantt]

does it require greater psycho motor control and hand to eye coordination than other surgeries?

You need to move instruments fractions of a mm with your hands.

 

[bertino]

You need to move instruments fractions of a mm with your hands.

OMG ! i have been really impressed by the doctors in ophth, and enjoyed the rotation, but this is scary. what if during learning i make countless people blind

 

[bertino]

Does anyone know How to delete this thread, since its not much active

 

[eyeguy85]

OMG ! i have been really impressed by the doctors in ophth, and enjoyed the rotation, but this is scary. what if during learning i make countless people blind

A wise attending overseeing your learning will make sure this does not happen. By the time you get to fellowship your surgical skills are generally much better than when you started operating and you can start tackling more complex (and riskier) procedures. That being said, complications happen if you operate enough no matter whether you are a resident, fellow, or attending. There is always some inherent risk in training someone to do a procedure.

As far as ophthalmic surgery being harder than other surgeries...I think that operating under a microscope is generally much more difficult than operating on a more macro level with loupes or with the naked eye. Some people are naturally great microscopic surgeons and others learn to be great surgeons over time.

 

[cp1]

I don't think it's that much harder. I've spent a lot of time with an ophthalmologist in the summer and he said that like with any other surgery it just takes practice. He said that we're not better than anybody else because we do microscopic surgery, and that we just practice.

 

[DrZeke]

I don't think it's that much harder. I've spent a lot of time with an ophthalmologist in the summer and he said that like with any other surgery it just takes practice. He said that we're not better than anybody else because we do microscopic surgery, and that we just practice.

You can do macro surgery and still be steady. If you don't eat, sleep, and watch your alcohol intake the day before microsurgery you can have a little tremor. Small adjustments make a big difference in micro surgery. Yes it's true that you learn and it's what we do. And many people turn out as fine surgeons. Certainly nobody says we are better than anyone else, but I do believe in is more challenging and takes longer to master.


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[Trefoil]

I think it depends on how you think and your personality. I'm slightly OCD, and I don't think macroscopic surgery would be a great fit for me. Everything I do has to be calculated and accurate. That type of thinking doesn't lend itself well to macroscopic surgery. They tear s*** up and shrug it off. That would drive me crazy. I'm an early resident, but the little experience I have with Ophtho just fits me better. It's clean and precise. I don't think one is harder than the other. They both require expertise and practice. My favorite joke/assessment I have heard was from an ophthalmology circulation nurse, when she sarcastically stated, "It's only eye surgery." Hopefully you understand her meaning.

 

[DrZeke]

This is true... Personality is important.

Though, I think this is a bit of a generalization to say they "tear **** up". I get where you are coming from but this depends on the surgeon and some things look rough but are not. Also maybe you have not yet seen orbit or strab surgery but it's a little more aggressive than a cataract extraction. And there's bleeding and tugging and cutting and sometimes breaking of bones.


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[TheLesPaul]

The controlled use of force requires much more skill than you would think by just observing...

 

[airplanes]

Ophthalmic surgery ideally requires a steady and delicate hand, characteristics which can be taught -- to an extent. It is not for everybody, especially those without full stereo vision.

Everything I do has to be calculated and accurate. That type of thinking doesn't lend itself well to macroscopic surgery. They tear s*** up and shrug it off. That would drive me crazy. I'm an early resident, but the little experience I have with Ophtho just fits me better. It's clean and precise....

I'm curious. What field of surgery do you consider un-calculated and inaccurate, dirty and imprecise? Sure, there may be more blood and guts in general surgery or orthopaedics, but no one is going around chopping people up willy nilly as you seem to imply.

 

[Trefoil]

Ophthalmic surgery ideally requires a steady and delicate hand, characteristics which can be taught -- to an extent. It is not for everybody, especially those without full stereo vision.



I'm curious. What field of surgery do you consider un-calculated and inaccurate, dirty and imprecise? Sure, there may be more blood and guts in general surgery or orthopaedics, but no one is going around chopping people up willy nilly as you seem to imply.

It may not seem uncalculated in comparison to most things; however, they are relatively uncalculated. I'm not saying that in a bad way. It takes bravery to cut into the unknown. If you think they always have a good idea of what is going to happen, and where they are at all times you are wrong. Some patients, especially those with extensive surgical histories are like hacking through weeds. It's like cutting through adhesion after adhesion trying to find a landmark to work off of. A single movement in general surgery (say a port placement) requires movement that is several inches in precision. The size of the port is the size of the eye...You literally can't compare the two. I'm not saying they are sloppy. I'm saying they can't afford the level of precision we depend on. They need to get the job done. Our intraocular lens shifts 1mm and our calculation is messed up. You can't go by mm in gen surg. There would be no way to get the job done. I loved the field, but I could never do it because they have to have the confidence to go in the completely wrong direction. Again, I have a ton of respect for the field, but there is no use in comparing them.

 

[Trefoil]

It may not seem uncalculated in comparison to most things; however, they are relatively uncalculated. I'm not saying that in a bad way. It takes bravery to cut into the unknown. If you think they always have a good idea of what is going to happen, and where they are at all times you are wrong. Some patients, especially those with extensive surgical histories are like hacking through weeds. It's like cutting through adhesion after adhesion trying to find a landmark to work off of. A single movement in general surgery (say a port placement) requires movement that is several inches in precision. The size of the port is the size of the eye...You literally can't compare the two. I'm not saying they are sloppy. I'm saying they can't afford the level of precision we depend on. They need to get the job done. Our intraocular lens shifts 1mm and our calculation is messed up. You can't go by mm in gen surg. There would be no way to get the job done. I loved the field, but I could never do it because they have to have the confidence to go in the completely wrong direction. Again, I have a ton of respect for the field, but there is no use in comparing them.

Also I would like to add that I never used the words dirty or inaccurate. There is definitely a difference. I think they generally are very clean and get the job done, but the scale is different. I honestly think they are "real surgeons," while ophthalmology is a field that is surgical. I have seen very complicated Stab, retina, and oculplastic procedures, and they just don't compare to the rawness of gen surg. I wouldn't want to be a general surgeon to be honest. It just doesn't fit me well. Again you have to have the confidence to go in the wrong direction. We precalculate most our stuff in ophthalmology. It's different, and we should pretend they are the same.

 

[DrZeke]

I don't think it was your intention StupidRoo, but no matter what you explain now you sounded like you were crapping on gen surg and non-microsurgeons.

The thread asked about the difficulty of ophthalmic surgery compared with gen surg. And your statements above don't have much to do with answering the question. Rather to blanket your comments: it's 'mostly your opinion on the elegance of gen surg vs ophthalmology. And the only part where you discuss difficulty you pretty much said they tear stuff up and that it is "not calculated". And now you are backtracking and saying "they have to go and do things with uncertainty and without a plan and that its scary." So maybe you are saying their surgeries are more difficult ?

I will say it sounds like you are predominantly referencing trauma. And I'm not sure how many evisceration, globe ruptures, enucleation you have seen, but trauma is often not pretty and calculated. You finally said "they don't compare to the rawness of general surgery" is your opinion. "We precalculate most of our stuff in ophthalmology". Also your opinion.

While everyone's opinion is valid you may find when it is bold or negative, whether or not it is that what you intended, people will disagree with you. So, no sense in backtracking.



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[Eye-eye]

You can do macro surgery and still be steady. If you don't eat, sleep, and watch your alcohol intake the day before microsurgery you can have a little tremor. Small adjustments make a big difference in micro surgery. Yes it's true that you learn and it's what we do. And many people turn out as fine surgeons. Certainly nobody says we are better than anyone else, but I do believe in is more challenging and takes longer to master.


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Do ophthalmologists tend to have to retire earlier than other surgeons, then, due to the slight unsteadiness which can come with age being a bigger issue?

 

[Eye-eye]

No, ophthalmologists practice on avg longer than other surgerons and even general practitioners- this is a paraphrase of a quote by the president of AAO b/c 1) they love what they do 2) you can still practice ophthalmology while not doing surgery- make less money but when you're 85, drive a jag, and have 3 kids who support you, you probably don't care about money anymore.


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What would that look like for someone in an inherently surgery-heavy subspecialty (e.g., VR surgery)? Do they just start acting more as general ophthalmologists?

 

[DrZeke]

VR is not an inherently busy surgical subspecialty. Most of them operate 1 day a week with an add on here and there for emergencies. Compare that to gen surg that have several OR days a week and 1-2 clinic days a week...

Ophthalmologist are surgeons but we are not a "surgery heavy" specialty and our surgeries are quite different than neurosurgery even though they have microsurgical techniques.


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