As a trainee in ophthalmology, every day you are learning more and more about the specialty. In addition, you will most likely be exploring the vast array of subspecialties that ophthalmology has to offer, and would probably be trying to figure out which one you would like to pursue as your career for the remainder of your working life!
One of the reasons that I am so passionate about ophthalmology is because I perceive it as the perfect combination of surgery and medicine. Throughout training, you will be exposed to a large range of ophthalmic surgeries such as the very common phacoemulsification, as well as more niche surgeries such as enucleation. As part of your training, you will be scheduled for time in operating theatres with ophthalmic consultants. During this time, you will be given the chance to observe, perform and assist in ophthalmic procedures. As a trainee, one should value these opportunities and make the most of them to learn as much about ophthalmic surgeries as you can. But how can one do that?
Of course, when you consider learning about ophthalmic surgery, having a solid foundation of anatomy knowledge is vital. As an ophthalmologist, and as part of the curriculum for the Part 1 Fellowship examination for the Royal College of Ophthalmologists, you are expected to have an excellent grasp of the anatomy of the eye, orbit, head and neck, and more [1]. In addition, when you are attending oculoplastic theatre lists, make sure that you have a good grasp of adnexal anatomy. As a piece of advice, when you are attending surgeries that are more niche, make sure that you have a general understanding of the basic principles too. For instance, if you are due to observe laser eye surgery, make sure that you know the different types and how they differ.
Repeated exposure is the key to familiarising yourself with any procedure, and getting to a stage where you can anticipate the next steps will be extremely advantageous. This will require hard work and lots of studying, but will pay off as you will be able consolidate your knowledge much better. It is difficult to always get this exposure through time in the operating theatre, so as an alternative, I would suggest that you could engage with surgical websites as a revision resource. As a visual learner, I find watching surgical videos to be a fantastic way to learn about ophthalmic surgical practice. They are also good for highlighting pitfalls or providing tips that are often difficult to convey through paragraphs in textbooks. If you speak to senior ophthalmic trainees or consultants, they most likely will be able to guide you in the right direction, however certain recommendations that I have are mentioned below and may provide you with a good starting point on how to approach learning about ophthalmic surgeries online [2,3].
“Remember to enjoy the process and really soak in the experience that you are operating on someone’s eye(s)!”
You should also familiarise yourself with the kits and instruments that are preferred for certain operations. Take time to speak to the scrub nurses and ensure that you know the names of each instrument so that you are not seeing them for the first time during the operation. Furthermore, some ophthalmic surgeons will also favour particular instruments, for example vicryl sutures. Don’t just take this at face value, and ask your consultant what their reason is for preferring this particular suture over another. After all, the surgeon will have done this procedure multiple times and this way you will have a better appreciation of the practical aspect and any factors that you will need to consider when it is your turn to be the main surgeon.
Lastly, what better way to practise for a surgical procedure than to get hands on? Practising for surgical ophthalmic surgeries can be done in various ways. I have discussed these methods in a previous Eye News article entitled Mastering clinical skills in ophthalmology but in summary, I would advise practising on the EYESi Surgical Simulator (which can be accessed at the Royal College of Ophthalmologists or at your local hospital) [4]. Simulation makes safe surgeons, and you can practise multiple times with the aim of improving your techniques without putting anyone at risk. Some have suggested that simulation allows you to familiarise yourself with vital techniques, and provides you with more confidence in the management of surgeries and their related complications [5]. I would advise that you liaise with your local simulation lead to explore further opportunities.
Another resource that I would recommend is to practise on model eyes, which have been redesigned over the years in order to resemble the human eye as much as possible. Model eyes are usually stocked by eye theatres, so do ask the staff if these are available to you.
Don’t forget that you are still in training, therefore you are there to learn. So, if you struggle, don’t suffer in silence, and speak up to get additional support if required. Ophthalmic surgeries are entertaining and extremely rewarding. Currently, we are still at the stage of trying to learn the procedures and want to excel in them, therefore a lot of the times will inevitably the pressure. However, remember to enjoy the process, and really soak in the experience that you are operating on someone’s eye(s)!
TAKE HOME MESSAGE
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Know your anatomy!
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Repeated exposure and continuous practise are the key to mastering ophthalmic surgeries.
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Visualising the procedure and knowing the next step will get you very far.
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Utilise all resources and speak to senior trainees for additional support if you are struggling.
References
1. The Royal College of Ophthalmologists. Part 1 FRCOphth Exam. 2022.
https://www.rcophth.ac.uk/examinations/
rcophth-exams/part-1-frcophth-exam/.
2. The University of Iowa. Department of Ophthalmology and Visual Sciences. 2022.
http://eyerounds.org/video/Refraction/
Intro-Optics-Refract-Errors/index.htm.
3. Oculoplastic EyeSurgeryVideos.net. 2022.
https://oculoplastic.eyesurgeryvideos.net/.
4. The Royal College of Ophthalmologists. EYESi Ophthalmic Surgical Simulators. 2022.
https://www.rcophth.ac.uk/training/simulation/
eyesi-ophthalmic-surgical-simulators/.
5. Nairn J, Benjamin L, Lockington D. Comment on: 'Ophthalmology Specialist Trainee Survey in the United Kingdom'. The need to increase familiarity with the management of predictable cataract surgery complications via simulation-ensuring competence to improve confidence. Eye (Lond). 2020 Epub ahead of print.
[All links last accessed September 2022].
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