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McCreery A, O'Regan A, Horgan N. Teaching of manual cataract extraction in ophthalmic surgical training programmes. Ir J Med Sci 2024:10.1007/s11845-024-03712-7. [PMID: 38771463 DOI: 10.1007/s11845-024-03712-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/11/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Manual cataract extraction techniques such as extracapsular cataract extraction (ECCE) or manual small incision cataract (MSICS) surgery have been replaced by phacoemulsification cataract surgery. Surgical training opportunities for manual techniques of cataract extraction are limited in modern surgical training programmes. AIMS This study evaluated the current trends of ECCE/MSICS training opportunities amongst trainees and trainers in the Irish Ophthalmic Surgical Training Program. METHODS An electronic survey was distributed to all ophthalmic surgical trainees and consultants in the country. It addressed the experience and exposure to ECCE/MSICS. RESULTS Nineteen of 33 (57%) trainees and 29 of 55 (55%) of consultants completed the survey. Twelve of 19 (63%) trainees viewed an ECCE procedure performed live. Twenty-seven of 29 (93%) consultants performed an ECCE procedure during their surgical career; 8 of 27 (30%) performed an ECCE within the last 1-3 years. Fourteen of 19 (74%) trainees stated they do not feel confident converting from phacoemulsification to ECCE independently. Sixteen of 19 (89%) trainees believe manual cataract extraction training should be included in their surgical training. Nineteen of 29 (65%) consultants believe training in manual cataract extraction should be part of the surgical training programme. CONCLUSIONS There is a paucity of manual cataract extraction being performed in Ireland, limiting live surgical training in this technique. This survey highlights the limited experience of trainees in this valuable skill that is occasionally required for a successful surgical outcome. The authors conclude that wet laboratory simulated training of manual cataract extraction will bridge this gap.
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Affiliation(s)
| | - Amy O'Regan
- St Vincent's University Hospital, Dublin, Ireland
| | - Noel Horgan
- St Vincent's University Hospital, Dublin, Ireland
- The Royal Victoria Eye and Ear Hospital, Dublin, Ireland
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Ní Dhubhghaill S, Sanogo M, Lefebvre F, Aclimandos W, Asoklis R, Atilla H, Creuzot-Garcher C, Curtin D, Cvenkel B, Flanagan L, Kivelä TT, Maino A, Martinez Costa R, Priglinger S, Prior Filipe H, Stopa M, Strong B, Sturmer J, Tassignon MJ, Ivekovic R, Bourcier T. Cataract surgical training in Europe: European Board of Ophthalmology survey. J Cataract Refract Surg 2023; 49:1120-1127. [PMID: 37867285 DOI: 10.1097/j.jcrs.0000000000001280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/02/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE To survey recently graduated European ophthalmologists concerning cataract surgery (CS) training opportunities. SETTING Countries affiliated to the European Board of Ophthalmology (EBO). DESIGN Cross-sectional study of anonymous survey results. METHODS A 23-question online survey was emailed to candidates who sat the EBO Diploma Examination as residents between 2018 and 2022. RESULTS 821 ophthalmologists from 30 countries completed the survey. The mean residency duration was 4.73 (SD 0.9) years. The mean reported number of entire CS procedures performed was 80.7 (SD 100.6) at the end of residency, but more than 25% of respondents (n = 210) had received no live CS training during their residency. The self-confidence (scale, 1 to 10) to perform a simple case or challenging case, manage posterior capsular rupture, and realize a corneal stitch were rated 4.1, 3.2, 4.2, 2.4, respectively. We observed extensive variation in clinical exposure to CS and self-reported confidence to perform CS between European trainees. Females reported a mean of 18% fewer entire procedures than their male colleagues and were also less confident in their surgical skills (P < .05). Trainees in residency programs longer than 5 years performed fewer procedures and were less confident than trainees in residences of shorter duration (P < .001). The importance of fellowships to complete surgical education was rated 7.7 out of 10. CONCLUSIONS CS training across European countries lacks harmony. Female ophthalmology trainees continue, as in other specialties, to experience apparent gender bias. European level recommendations seem necessary to raise and harmonize competency-based CS training programs and promote post-residency fellowship training programs.
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Affiliation(s)
- Sorcha Ní Dhubhghaill
- From the Department of Ophthalmology, Antwerp University and University Hospital of Antwerp, Antwerp, Belgium (Ní Dhubhghaill, Tassignon); Department of Ophthalmology, Strasbourg University Hospital, NHC, FMTS, University of Strasbourg, Strasbourg, France (Sanogo, Bourcier); Department of Biostatistics, Strasbourg University Hospital, Civil Hospital, FMTS, University of Strasbourg, Strasbourg, France (Lefebvre); King's College Hospital, London, United Kingdom (Aclimandos); Department of Ophthalmology, Center of Eye Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (Asoklis); Department of Ophthalmology, Ankara University, School of Medicine, Ankara, Turkey (Atilla); Department of Ophthalmology, Dijon University Hospital, University of Dijon, Dijon, France (Creuzot-Garcher); Consultant Ophthalmologist, Clinical Lecturer, Royal College of Surgeons in Ireland, Dublin, Ireland (Curtin); Department of Ophthalmology, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia (Cvenkel); EBO Secretariat Office, Agenda Communications and Conference Services, Ltd., Dublin, Ireland (Flanagan, Strong); Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (Kivelä); Manchester Royal Eye Hospital, Manchester, United Kingdom (Maino); Department of Ophthalmology, Hospital Universitario y Politécnico La Fe, University of Valencia, Valencia, Spain (Martinez Costa); Department of Ophthalmology, LMU Munich, Germany (Priglinger); Department of Ophthalmology, West Lisbon Hospitals Center, Hospital Egas Moniz, Portugal (Prior Filipe); Department of Ophthalmology, Poznan University Hospital, Poznan University of Medical Sciences, Poland (Stopa); Department of Ophthalmology, Cantonal Hospital Winterthur, University of Zurich, Switzerland (Sturmer); Department of Ophthalmology, University Medical Centre Sestre Milosrdnice, Zagreb, Croatia (Ivekovic)
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Ifantides C, SooHoo JR, Christopher KL. Impact of a formal manual small-incision cataract surgery curriculum in an American ophthalmology residency program. Indian J Ophthalmol 2023; 71:2474-2477. [PMID: 37322664 PMCID: PMC10417980 DOI: 10.4103/ijo.ijo_1339_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/02/2022] [Accepted: 10/20/2022] [Indexed: 06/17/2023] Open
Abstract
Purpose Global ophthalmology educational activities often include the ability of ophthalmology residents to partake in low-resource clinical care at home and abroad. Low-resource surgical techniques have become a pillar of education during formalized global ophthalmology fellowships. A formal manual small-incision cataract surgery (MSICS) curriculum was started in the University of Colorado's residency training program to meet the growing demand for this surgical skill and to allow for more sustainable outreach work from our graduates. The survey was conducted to collect evaluations on the value of formal MSICS training within a United States-based residency program. Methods This was a survey study in a US ophthalmology residency program. A formal MSICS curriculum was created that included didactic lectures on epidemiology of global blindness, MSICS technique, and how MISCS compared to phacoemulsification in terms of cost and sustainability in low-resource settings, followed by a formal wet lab experience. Residents were then exposed to MSICS procedures in the operating room (OR) under supervision of an experienced MSICS surgeon. An anonymous online survey was conducted on three consecutive cohorts of recently graduated senior ophthalmology residents from 2019 to 2021 with the aim of eliciting opinions about and outcomes from the new curriculum. Results Fifteen graduating senior residents comprised the three cohorts with a 100% survey response rate. All residents agreed or strongly agreed that "MSICS is a valuable skill to have". Eighty percent of respondents agreed or strongly agreed that "exposure to MSICS has increased my likelihood of doing any type of outreach work in the future" and 86.67% agreed or strongly agreed that "exposure to MSICS increased my understanding about sustainable outreach work". The average number of cases assisted or performed per resident was 8.2 (SD 2.7, range 4-12). Conclusion A formal MSICS curriculum for US-based ophthalmology residents was well-received by the trainees. The majority felt it increased their likelihood of pursuing and improved their understanding of sustainable outreach work. The curriculum, which included lectures, wet lab training, and formal teaching in the OR, could add value to a residency program's curriculum. Furthermore, a formal domestic program can avoid ethical pitfalls that can be seen with resident teaching during international mission work.
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Affiliation(s)
- Cristos Ifantides
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Jeffrey R SooHoo
- Department of Ophthalmology, University of Colorado, Aurora, CO, USA
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Knight LN, Royal K. Training Veterinary Ophthalmology Residents on Cataract Surgery (Part A: Diplomate's Survey). JOURNAL OF VETERINARY MEDICAL EDUCATION 2023:e20220081. [PMID: 36917612 DOI: 10.3138/jvme-2022-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The purpose of this study was to explore the teaching methods used to train residents in cataract surgery at academic and private practice institutions. A descriptive survey was distributed online to 186 active supervising diplomates of the American Board of Veterinary Ophthalmologists (ABVO) listserve. The survey included items about various educational resources and techniques available to ophthalmology residents when performing cataract surgery. Thirty-seven (19.9%) supervising diplomates completed the survey. Most supervising diplomates (29, 78.4%) required supervised practice in the wet lab. Fourteen supervising diplomates (37.8%) provided mandatory cataract surgery lectures. Nine diplomates (24.3%) required their residents to attend a formal phacoemulsification wet lab course. There was no difference in the number of diplomates who allowed their residents to perform cataract surgery as the primary surgeon during their second year compared to any other year. Thirty-three surveyed diplomates supported the idea of creating an assessment tool to improve surgical competency. This article describes the current trends in veterinary ophthalmology residency education and provides support for the creation of an assessment tool to improve surgical competency. The goal is to stimulate future research on how educators can effectively train veterinary ophthalmology residents to improve surgical proficiency.
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Affiliation(s)
- LaTisha N Knight
- Comparative Ophthalmology, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607 USA
| | - Kenneth Royal
- Office of Academic Affairs, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24061 USA
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Knight LN, Royal KD, Robertson JB. Hurdles of Cataract Surgery: Veterinary Ophthalmology Resident's Perspective (Part B). JOURNAL OF VETERINARY MEDICAL EDUCATION 2023:e20220082. [PMID: 36888897 DOI: 10.3138/jvme-2022-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The purpose of this study was to describe veterinary ophthalmology residents' perceived preparedness for performing cataract surgery who are currently enrolled in, or recently graduated from, veterinary academic or private practice institutions. A descriptive survey was distributed online to 127 residents at academic and private practice training programs in the United States. The survey included items about educational resources available for residents and techniques commonly taught during cataract surgery. Residents were asked to describe their perceived preparedness in performing various surgical steps or techniques, difficulty of each surgical step, and the available educational resources. Thirty-five (27.5%) residents completed the survey and were included in this study. Residents who had access to wet labs gained surgical competency in creating a clear corneal incision, capsulorhexis, and wound closure. They reported sculpting with the phacoemulsification handpiece, quadrant or cortical removal, and capsulorhexis as most difficult and were not as prepared or a little prepared in performing capsulorhexis and sculpting during active phacoemulsification. When comparing residents' perceived competency before and after their first surgical experience, there was a significant change in their ability to perform all surgical steps except hydrodissection (p < .05). Cataract surgery is one of the more advanced surgical skills obtained during residency training. Supervised wet lab time improves a resident's preparedness for executing certain surgical steps. However, further research is needed to determine whether educational resources such as structured curriculum or virtual simulation may improve residents' preparedness for executing surgical steps not easily replicated in a wet lab.
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Affiliation(s)
- LaTisha N Knight
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607 USA
| | - Kenneth D Royal
- Office of Academic Affairs, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24061 USA. Comparative Ophthalmology, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607 USA
| | - James B Robertson
- Office of Research, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607 USA
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Bhullar PK, Venkateswaran N. Ophthalmology Residency in the United States: The Case for a National Curriculum. Semin Ophthalmol 2023; 38:167-177. [PMID: 36653736 DOI: 10.1080/08820538.2022.2152713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
To identify strategies for effective curriculum development and implementation in United States (US) ophthalmology residency training programs. A literature review was conducted for all English-language PubMed/Medline articles relating to ophthalmology residency education or curriculum/curricula. Despite ACGME-defined program requirements outlining curricular goals for US ophthalmology residency training programs, there is no comprehensive, national curriculum with detailed plans for instruction of necessary topics within the 36-month residency training period. Several articles identify a need for detailed curricula on various topics, propose ideas on how residency programs could create curricula, and explore ways of assessing resident competence. There is a paucity of literature evaluating how ophthalmology residents best learn various ophthalmology topics. We need to develop an intentional, comprehensive, and timely national curriculum for ophthalmology residency programs in the US, with detailed plans on how to meet curricular objectives and consideration of the most effective teaching strategies for different ophthalmology concepts.
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Temporal artery biopsy: time for a rethink on training? Eye (Lond) 2023; 37:506-510. [PMID: 35190668 PMCID: PMC8859846 DOI: 10.1038/s41433-022-01963-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/19/2022] [Accepted: 02/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Temporal artery biopsy (TAB) is often performed by ophthalmology trainees without direct supervision. The traditional model of 'see one, do one, teach one' still prevails in most units. Whilst it is generally a safe procedure, damage to the temporal branch of the facial nerve has been reported when harvesting the frontal branch of the superficial temporal artery. METHODS A survey of trainees from Wessex, Wales, London and Severn deaneries was performed to look at current training techniques, anatomical knowledge and practice. RESULTS 38 trainees responded to the survey, with complete responses from 28 participants. Formal teaching of the anatomical considerations in TAB was not reported by any trainee, with informal teaching being standard practice. Whilst 61% of respondents reported having learnt about the anatomical 'danger zone' for facial nerve damage, 97% of trainees chose an incision that fell within this zone when given a choice between potential incision sites. CONCLUSION TAB remains a largely trainee-taught, trainee-performed procedure. Most trainees are not aware of how to avoid the risk of damage to the temporal branch of the facial nerve. We suggest harvesting the parietal branch of the temporal artery via an incision outside the anatomical 'danger zone'. In our experience, this is an easily taught technique that minimises the potential risk of damage to the frontal branch of the facial nerve.
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Joshi R, Raza N, Wadekar P, Patil N, Tamboli S, Surwade T, Bansode N, Turankar A. To study the learning curve of capsulorhexis in manual small incision cataract surgery among postgraduate residents in central India. Saudi J Ophthalmol 2023; 37:15-19. [PMID: 36968772 PMCID: PMC10032284 DOI: 10.4103/sjopt.sjopt_135_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/03/2022] [Accepted: 07/28/2022] [Indexed: 03/11/2023] Open
Abstract
PURPOSE To evaluate the learning curve of continuous curvilinear capsulorhexis (CCC) and to assess the number of surgeries required to master it among residents in a postgraduate teaching institute. METHODS The present prospective observational study was based on the completion time and complication rates related to CCC performed using various techniques by 10 students in the 2nd (JR2) and 3rd-year (JR3) of residency. CCC was performed either by a cystotome or capsulorhexis forceps or by a combined method in 253 eyes, of which 160 eyes (63.2%) were operated by JR3 and 93 (36.8%) by JR2. The complication rates were studied with respect to the number of capsular extensions, posterior capsular rent (PCR), zonular dehiscence, need for senior surgical assistance, and nucleus drop. RESULTS The average time required for the completion of CCC was 412 ± 90.5 s. The average number of times residents required to fill the anterior chamber with viscoelastic was 6.9 ± 1.4. The average size of CCC was 7 ± 0.66 mm. Extended CCC was the most common complication. JR2 required assistance from a senior surgeon in 47 eyes (50.5%), whereas JR3 required assistance in 39 eyes (24.4%) (P = 0.0001). The rate of PCR was not significantly different in JR2 (7.5%) and JR3 (8.8%). CONCLUSION CCC is a difficult step to master in the trainee. Focusing and practicing on this step will help to reduce the complications and maximize proficiency. Approximately 6-eight surgeries are required to master CCC.
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Balas M, Kwok JM, Miguel A, Rai A, Rai A, Ahmed IIK, Schlenker MB. The Cataract Surgery Learning Curve: Quantitatively Tracking a Single Resident's Operative Actions Throughout Their Training. Am J Ophthalmol 2022; 249:82-89. [PMID: 36581189 DOI: 10.1016/j.ajo.2022.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/01/2022] [Accepted: 12/04/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE To track operative phases of cataract surgery over a resident's training to measure action times and frequencies as a surrogate for competency and skill progression. DESIGN An n = 1 panel study. METHODS Cataract surgery video recordings performed by a single resident between 2021-2022 were collected. Only full-length videos of adequate quality without supervisor intervention were included. The start and end times of 19 distinct operative phases of cataract surgery were manually labeled by a trained annotator. Timeseries analysis was employed to measure the direction and magnitude of trends in the resident's surgical timing for each action across their first year of training. RESULTS The dataset comprised 100 videos spread across the resident's sixth to 760th cases. The median total time was 11.6 minutes (IQR 10.1-14.4 minutes), with overall speed increasing at a rate of 43.4 seconds for every 10 videos (95% CI 35.1, 52.7 seconds). Nine operative phases significantly decreased in time throughout training. The main incision, phacoemulsification, and hydrodissection had the greatest improvements in speed relative to their average procedural time. There was an average of 26.9 distinct operative actions (excluding idle periods) in each video (range 20-50). CONCLUSIONS This is the first study to quantitatively track operative times and frequencies across all relevant actions in cataract surgery and derive learning curves for each. Consistent with previous works, it was found that a basic level of surgical competency was achieved after performing 80 cases. In addition, results from this study indicated that the next level in skill advancement towards surgical finesse occurs after 300 cases.
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Affiliation(s)
- Michael Balas
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (M.B.)
| | - Jason M Kwok
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (J.M.K., A.R., A.R., I.I.K.A., M.B.S.); Kensington Eye Institute, Toronto, Ontario, Canada (J.M.K., A.R., A.R., I.I.K.A., M.B.S.)
| | - Ana Miguel
- Department of Ophthalmology, Private Hospital of La Baie, Avranches, France (A.M.); Department of Ophthalmology, Central University Hospital of Caen, Caen, France (A.M.)
| | - Amrit Rai
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (J.M.K., A.R., A.R., I.I.K.A., M.B.S.); Kensington Eye Institute, Toronto, Ontario, Canada (J.M.K., A.R., A.R., I.I.K.A., M.B.S.); Prism Eye Institute, Mississauga, Ontario, Canada (A.R., A.R., I.I.K.A., M.B.S.)
| | - Amandeep Rai
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (J.M.K., A.R., A.R., I.I.K.A., M.B.S.); Kensington Eye Institute, Toronto, Ontario, Canada (J.M.K., A.R., A.R., I.I.K.A., M.B.S.); Prism Eye Institute, Mississauga, Ontario, Canada (A.R., A.R., I.I.K.A., M.B.S.)
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (J.M.K., A.R., A.R., I.I.K.A., M.B.S.); Kensington Eye Institute, Toronto, Ontario, Canada (J.M.K., A.R., A.R., I.I.K.A., M.B.S.); Prism Eye Institute, Mississauga, Ontario, Canada (A.R., A.R., I.I.K.A., M.B.S.)
| | - Matthew B Schlenker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (J.M.K., A.R., A.R., I.I.K.A., M.B.S.); Kensington Eye Institute, Toronto, Ontario, Canada (J.M.K., A.R., A.R., I.I.K.A., M.B.S.); Prism Eye Institute, Mississauga, Ontario, Canada (A.R., A.R., I.I.K.A., M.B.S.).
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Tsai ASH, Yeo BSY, Anaya Alaminos R, Wong CW, Tham CC, Fang SK, Lam DSC, González-Andrades M, Ang M. Survey of Ophthalmology Training Experiences Among Young Ophthalmologists in the Asia-Pacific. Asia Pac J Ophthalmol (Phila) 2022; 11:434-440. [PMID: 36102646 DOI: 10.1097/apo.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To describe ophthalmology training experiences across the Asia-Pacific (APAC). DESIGN Survey study. METHODS We utilized an anonymous online survey, which was previously validated and conducted in Europe, through Young Ophthalmologist leaders from the national member societies of the Asia-Pacific Academy of Ophthalmology (APAO) from September 2019 to July 2021. Responses were based on a 5-point Likert scale (where applicable) and data were analyzed using Microsoft Excel. Our main outcome measures were differences between regions, that is, Southeast Asia (SEA) and Western Pacific (WP); and seniority, that is, trainees/junior ophthalmologists and senior ophthalmologists. RESULTS We collated 130 responses representing 20 regions in the APAC region. The year of completion of ophthalmic training ranged from 1999 to 2024. The mean duration of training was 3.7±1.0 years. Most (98/130, 75%) indicated an interest for a common training standard across the APAC. Comparing SEA and WP trainees, both regions had similar working environments, but those in SEA reported significantly lower remuneration than their counterparts in WP ($600 vs $3000, P <0.05). WP trainees performed more phacoemulsification surgeries (76 WP vs 19 SEA), while SEA trainees conducted more manual small incision cataract surgeries (157 WP vs 1.5 SEA per duration of training). Senior ophthalmologists performed more cataract surgeries (210.9 senior ophthalmologists vs 40.1 junior ophthalmologists). Trainees had less confidence in medical competency areas such as interpreting an electroretinogram/visual evoked potential/electrooculogram (SEA=1.8, WP=2.1) and conducting an angiography (SEA=2.8, WP=3.4). CONCLUSIONS Our study highlighted heterogeneity among ophthalmology training experiences in the APAC region, with the majority indicating an interest in a common training standard.
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Affiliation(s)
- Andrew S H Tsai
- Singapore National Eye Centre, Singapore, Singapore
- DUKE NUS Medical School, Singapore, Singapore
| | - Brian S Y Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roberto Anaya Alaminos
- Department of Ophthalmology, Hospital Universitario San Cecilio, VISIÓON Ophthalmic Clinic, Granada, Spain
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore, Singapore
- DUKE NUS Medical School, Singapore, Singapore
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Dennis S C Lam
- C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
| | - Miguel González-Andrades
- Department of Ophthalmology, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital and University of Cordoba, Cordoba, Spain
| | - Marcus Ang
- Singapore National Eye Centre, Singapore, Singapore
- DUKE NUS Medical School, Singapore, Singapore
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The Limitations of Surgical Learning from Watching YouTube VDOs. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02903-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Jeang LJ, Liechty JJ, Powell A, Schwartz C, DiSclafani M, Drucker MD, McDowell WM. Rate of Posterior Capsule Rupture in Phacoemulsification Cataract Surgery by Residents with Institution of a Wet Laboratory Course. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2022. [DOI: 10.1055/s-0042-1744270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Purpose To determine if a structured surgical wet laboratory curriculum for ophthalmology residents reduced the rate of posterior capsule rupture (PCR) in phacoemulsification cataract surgery.
Setting James A. Haley Veterans' Hospital, Tampa, FL.
Design Retrospective cohort study.
Methods The study assessed resident-performed phacoemulsification cataract cases from 2011 to 2017, after the creation of a wet laboratory course. Primary outcome measure was PCR. If present, timing of complication, dropped lens fragments, and the need for anterior vitrectomies were noted. Self-reported rates of PCR prior to institution of a wet laboratory course (2010–2011) were compared with cases done by residents who completed the course (2011–2017).
Results A total of 3,445 cases were reviewed of which 2.44% (84 cases) noted PCR. Of these, 19% (16) had dropped lens fragments, and 60.7% (51) required anterior vitrectomy. Sixty-nine cases documented timing of PCR with the majority, 58%, occurring during phacoemulsification. When comparing rates of PCR in cases done prior to the presence of a wet laboratory course versus after, there was a significant reduction observed (5.20% before vs. 2.44% after).
Conclusion In the presence of a wet laboratory curriculum, the rate of PCR decreased dramatically. The average rate was lower than those reported at other training programs (2.6–9.9%). Most PCR occurred during phacoemulsification, suggesting need for further focused instruction in this step.
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Affiliation(s)
- Lauren J. Jeang
- University of South Florida Department of Ophthalmology, Tampa, Florida
| | - Jacob J. Liechty
- University of South Florida Department of Ophthalmology, Tampa, Florida
| | - Asyvia Powell
- University of South Florida School of Medicine, Tampa, Florida
| | | | - Mark DiSclafani
- University of South Florida Department of Ophthalmology, Tampa, Florida
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Lin JC, Yu Z, Scott IU, Greenberg PB. Virtual reality training for cataract surgery operating performance in ophthalmology trainees. Cochrane Database Syst Rev 2021; 12:CD014953. [PMID: 34931701 PMCID: PMC8689714 DOI: 10.1002/14651858.cd014953.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cataract surgery is the most common incisional surgical procedure in ophthalmology and is important in ophthalmic graduate medical education. Although most ophthalmology training programs in the United States (US) include virtual reality (VR) training for cataract surgery, comprehensive reviews that detail the impact of VR training on ophthalmology trainee performance are lacking. OBJECTIVES To assess the impact of VR training for cataract surgery on the operating performance of postgraduate ophthalmology trainees, measured by operating time, intraoperative complications, postoperative complications, supervising physician ratings, and VR simulator task ratings. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register), Ovid MEDLINE, Embase.com, PubMed, LILACS, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 14 June 2021. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing VR training to any other method of training, including non-VR simulation training (e.g., wet laboratory training), didactics training, or no supplementary training in postgraduate ophthalmology trainees. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. Primary outcomes were operating times in the operating room and intraoperative complications. Secondary outcomes were operating times in simulated settings, simulator task ratings, and supervising physician ratings, either in the operating room or simulated settings. MAIN RESULTS We included six RCTs with a total of 151 postgraduate ophthalmology trainees ranging from 12 to 60 participants in each study. The included studies varied widely in terms of geography: two in the US, and one study each in China, Germany, India, and Morocco. Three studies compared VR training for phacoemulsification cataract surgery on the Eyesi simulator (VRmagic, Mannheim, Germany) with wet laboratory training and two studies compared VR training with no supplementary training. One study compared trainees who received VR training with those who received conventional training for manual small incision cataract surgery on the HelpMeSee simulator (HelpMeSee, New York, NY). Industry financially supported two studies. All studies had at least three domains judged at high or unclear risks of bias. We did not conduct a meta-analysis due to insufficient data (i.e., lack of precision measurements, or studies reported only P values). All evidence was very low-certainty, meaning that any estimates were unreliable. The evidence for the benefits of VR training for trainees was very uncertain for primary outcomes. VR-trained trainees relative to those without supplementary training had shorter operating times (mean difference [MD] -17 minutes, 95% confidence interval [CI] -21.62 to -12.38; 1 study, n = 12; very low-certainty evidence). Results for operating time were inconsistent when comparing VR and wet laboratory training: one study found that VR relative to wet laboratory training was associated with longer operating times (P = 0.038); the other reported that two training groups had similar operating times (P = 0.14). One study reported that VR-trained trainees relative to those without supplementary training had fewer intraoperative complications (P < 0.001); in another study, VR and conventionally trained trainees had similar intraoperative complication rates (MD -8.31, 95% CI -22.78 to 6.16; 1 study, n = 19; very low-certainty evidence). For secondary outcomes, VR training may have similar impact on trainee performance compared to wet laboratory and greater impact compared to no supplementary training, but the evidence was very uncertain. One study reported VR-trained trainees relative to those without supplementary training had significantly reduced operating time in simulated settings (P = 0.0013). Another study reported that VR-trained relative to wet laboratory-trained trainees had shorter operating times in VR settings (MD -1.40 minutes, 95% CI -1.96 to -0.84; 1 study, n = 60) and similar times in wet laboratory settings (MD 0.16 minutes, 95% CI -0.50 to 0.82; 1 study, n = 60). This study also found the VR-trained trainees had higher VR simulator ratings (MD 5.17, 95% CI 0.61 to 9.73; 1 study, n = 60). Results for supervising physician ratings in the operating room were inconsistent: one study reported that VR- and wet laboratory-trained trainees received similar supervising physician ratings for cataract surgery (P = 0.608); another study reported that VR-trained trainees relative to those without supplementary training were less likely to receive poor ratings by supervising physicians for capsulorhexis construction (RR 0.29, 95% CI 0.15 to 0.57). In wet laboratory settings, VR-trained trainees received similar supervising physician ratings compared with wet laboratory-trained trainees (MD -1.50, 95% CI -6.77 to 3.77; n = 60) and higher supervising physician ratings compared with trainees without supplementary training (P < 0.0001). However, the results for all secondary outcomes should be interpreted with caution because of very low-certainty evidence. AUTHORS' CONCLUSIONS: Current research suggests that VR training may be more effective than no supplementary training in improving trainee performance in the operating room and simulated settings for postgraduate ophthalmology trainees, but the evidence is uncertain. The evidence comparing VR with conventional or wet laboratory training was less consistent.
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Affiliation(s)
- John C Lin
- Program in Liberal Medical Education, Brown University, Providence, Rhode Island, USA
| | - Zane Yu
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Ingrid U Scott
- Ophthalmology and Public Health Sciences, Penn State College of Medicine, State College, Hershey, Pennsylvania, USA
| | - Paul B Greenberg
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Tsou BC, Vongsachang H, Purt B, Srikumaran D, Justin GA, Woreta FA. Cataract Surgery Numbers in U.S. Ophthalmology Residency Programs: An ACGME Case Log Analysis. Ophthalmic Epidemiol 2021; 29:688-695. [PMID: 34913813 DOI: 10.1080/09286586.2021.2015395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe and assess the cataract experience of ophthalmology residents throughout the United States (U.S.). METHODS Cataract procedures logged by graduating ophthalmology residents nationwide and published by the Accreditation Council for Graduate Medical Education (ACGME) from 2009 to 2020 were analyzed using linear regression on log-transformed response variables with robust variance. RESULTS As primary surgeon, average numbers logged for phacoemulsification increased yearly by an average of 4.1% prior to 2019 and then decreased by 22.1% in 2019 for an overall average yearly increase of 2.9% (95% CI: 0.5, 5.4%, p = .03), non-phacoemulsification extracapsular extraction decreased yearly by an average of 4.6% (95% CI: -7.7, -1.5%, p = .01), other cataract/intraocular lens surgeries decreased yearly by an average of 8.4% (95% CI: -10.1, -6.6%, p < .001), anterior vitrectomies decreased yearly by an average of 12.5% (95% CI: -14.9, -10.1%, p < .001), and laser capsulotomies increased yearly by an average of 6.0% prior to 2019 and then decreased by 3.0% for an overall average yearly increase of 5.3% (95% CI: 4.5, 6.2%, p < .001). As assistant, average numbers logged in all ACGME minimum categories showed decreasing trends. CONCLUSIONS Over the last decade, the average numbers of phacoemulsification and laser capsulotomies logged by residents as primary surgeon increased while other ACGME cataract minimum procedures decreased. Surgical volume in 2019-20 was lower due to the coronavirus disease-19 pandemic but higher than from 2009 to 2013.
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Affiliation(s)
- Brittany C Tsou
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hursuong Vongsachang
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Boonkit Purt
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Grant A Justin
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Evidence-based cataract surgery teaching milestones - a guide to evaluate resident achievement. J Cataract Refract Surg 2021; 48:456-461. [PMID: 34924519 DOI: 10.1097/j.jcrs.0000000000000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Develop evidence-based milestones for cataract surgery teaching and identify performance indicators. SETTING Edmonton, Alberta, Canada. DESIGN Retrospective cohort study. METHODS Operative records from a single surgeon were reviewed for resident participation when learning cataract surgery over a 14-year time period. Time to complete a resident's first complete case was the primary outcome. Secondary outcomes included mean time to perform each categorical step of the procedure, number of cases participated in, rate of participation, complex case involvement and complications. Strong resident performance was defined as time to first complete case one standard deviation quicker than mean performance; weak performance was the opposite. RESULTS Residents performed beginner steps for 3.1 ± 3.2 months, intermediate steps until month 4.3 ± 3.3, and by month 5.1 ± 3.4 residents were able to do complete cases. Time to perform a complete case increases with lower case participation (p=0.02); mean proportion of complex cases that a resident participated in was 7.9% (n=17.6 ± 10.0).; Less than 1% of resident cases resulted in posterior capsular rupture (n=1.4 ± 1.3 cases). Based on this data, weaker achievement is defined as failure to achieve beginner-step competency by month 6.3, intermediate step competency by month 7.6, or inability to perform a complete case by month 8.5. In this dataset, 23.1% of residents met this definition (n=3). CONCLUSIONS Residents who train with multiple teachers during a focused cataract surgery rotation can perform complete cases after a mean of 5.1 ± 3.4 months with a low PCR rate.
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Lauer AK, Chung SM, Tu DC, SooHoo JR, Potts JR. Trends in Ophthalmology Resident Operative Experience and the Early Impact of the COVID-19 Pandemic. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2021. [DOI: 10.1055/s-0041-1740052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Purpose This study aimed to evaluate trends in ophthalmology resident operative experience and the early impact of the novel coronavirus disease 2019 (COVID-19) pandemic.
Design Present study is a retrospective analysis of the Accreditation Council for Graduate Medical Education (ACGME) Case Log System.
Participants Anonymized graduating resident case logs from 2011 to 2020 academic years (AYs) were examined for this study.
Methods Regression analysis for each procedure category was performed to identify trends between 2011 and 2019 AYs. Unpaired two-tailed t-test compared 2018 to 2019 and 2019 to 2020 AY's for each category surgeon (S) and as surgeon and assistant (S + A).
Main Outcome Measures Mean and median cases as (S) and (S + A) during 2011 to 2019 AYs. Comparison between 2018 to 2019 and 2019 to 2020 AY's for each category as (S) and (S + A) to evaluate the impact of the COVID-19 pandemic.
Results Total ophthalmology procedures as (S) rose from a mean of 479.6 to 601.3 (p < 0.001; R
2 = 0.96; Δ/year = 16.9) and a median of 444 to 537 (p < 0.001; R
2 = 0.97; Δ/year = 13.1). Total procedures as (S + A) rose from a mean of 698.1 to 768 (p < 0.01; R
2 = 0.83; Δ/year = 9.07) and a median of 677 to 734 (p < 0.05; R
2 = 0.61; Δ/year = 6.64). Cataract procedures as (S) rose from a mean of 152.8 to 208 (p < 0.001; R
2 = 0.99; Δ/year = 7.98) and a median of 146 to 197 (p < 0.001; R
2 = 0.97; Δ/year = 7.87). Cataract procedures as both (S + A) rose from a mean 231.4 to 268.7 (p < 0.001; R
2 = 0.95; Δ/year = 5.5) and a median of 213 to 254 (p < 0.001; R
2 = 0.93; Δ/year = 5.33). Between 2018 to 2019 and 2019 to 2020 AYs, the first pandemic year was associated with significant reductions in total procedures (601.3–533.7 [p < 0.0001]) as (S) and 768.0 to 694.4 (p < 0.0001) as (S + A), cataract surgery (208–162.2 [p < 0.0001]) as (S) and 268.7 to 219.1 (p < 0.0001) as (S + A), and glaucoma surgery (16.3–14.2 [p = 0.0068]) as (S) and 25.6 to 22.6 (p = 0.0063) as (S + A).
Conclusion During 2011 to 2019 AYs, cataract, intravitreal injections, glaucoma, and total procedures increased significantly. During the early period of the COVID-19 pandemic (2019–2020 AY), national halting of elective procedures had a precipitous effect on resident cataract surgery experience to volumes similar to 2013 to 2014 AY where the mean was twice the current required minimum number. With few exceptions, other procedure volumes remained stable.
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Affiliation(s)
- Andreas K. Lauer
- Casey Eye Institute, Oregon Health Science University, Department of Ophthalmology 515 SW Campus Drive, Portland, Oregon 97239
| | - Sophia M. Chung
- Departments of Ophthalmology and Visual Sciences and Neurology, University of Iowa Hospitals and Clinics, Hawkins Dr, Iowa City, Iowa 52242
| | - Daniel C. Tu
- Casey Eye Institute, Oregon Health Science University, Department of Ophthalmology 515 SW Campus Drive, Portland, Oregon 97239
- Operative Care Division, Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239
| | - Jeffrey R. SooHoo
- Sue Anschutz-Rodgers Eye Center, Department of Ophthalmology 1675 Aurora Ct, Aurora, Colorado 80045
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Gandhi Bhatt A, Dole KS, Deshpande M, Bharucha K, Kalyani VKS. Impact of a structured training program to enhance skills in phacoemulsification surgery. Indian J Ophthalmol 2021; 69:3697-3702. [PMID: 34827025 PMCID: PMC8837341 DOI: 10.4103/ijo.ijo_232_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose The aim of this study was to determine whether the introduction of a structured short-term phacoemulsification training program improved the ICO-OSCAR (International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric) score and the learning curve of the trainees and decreased the complication rates of the cases. Methods This study was a retrospective, observational study conducted in a tertiary eye care hospital in India. The study was conducted from March 2018 to October 2019 based on a structured phacoemulsification training program introduced in January 2019. The trainees enrolled in the phacoemulsification training program were divided into two groups: Group 1 (n = 33), who underwent training before the introduction of the structured program, and Group 2 (n = 29), who underwent the training after the introduction of the structured training program. Each trainee performed 20 cases. Group 1 training consisted of wet-lab and phacoemulsification surgeries. Group 2 training program comprised three modules over 5 weeks and a preassessment examination. Premodule 1 imparted cognitive skills; Module 1 was on structured wet-lab, Module 2 was about phacoemulsification step surgery, and Module 3 had independent complete surgeries. Group 2 also underwent compulsory Observation of cases being performed in the operation theater, surgical video recording review, and formative feedback. Mean OSCAR score comparison was done for both the groups. The OSCAR score was also calculated case-wise to obtain the learning curve with respect to the entry and exit levels, by classifying the trainees in each group as Novice, Beginner, Advanced Beginner, or Competent. A comparison of the posterior capsular rupture (PCR) rates and vision at discharge of all the cases was done. Results Group 2 had a significantly better mean OSCAR score than Group 1 (4.03 and 3.43, respectively; P < 0.001). The PCR rate of the cases was significantly lower in Group 2 than in Group 1 (9.14% and 20.30%, respectively; P < 0.001). Group 2 had a significantly better visual acuity outcome of the cases than Group 1. Group 1 started as Novice (OSCAR score: 2), whereas Group 2 started as Beginner (OSCAR score: 3). Group 2 reached the Advanced Beginner level eight to 10 cases prior to Group 1. Conclusion A structured training curriculum can make a significant difference in the training experience of the trainees and enable better surgical outcomes and a decrease in the complication rates.
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Affiliation(s)
- Anuprita Gandhi Bhatt
- Department of General Ophthalmology, H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Kuldeep S Dole
- Department of General Ophthalmology, H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Madan Deshpande
- Department of General Ophthalmology, H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Khurshed Bharucha
- Department of General Ophthalmology, H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - V K S Kalyani
- Department of General Ophthalmology, H. V. Desai Eye Hospital, Pune, Maharashtra, India
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18
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Landis ZC, Fileta JB, Kunselman AR, Sassani J, Scott IU. Impact of Video Describing Cataract Surgical Simulator Training on Patients' Perceptions of Resident Involvement in Cataract Surgery. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2021. [DOI: 10.1055/s-0041-1728659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Purpose The aim of this article is to investigate the impact of a 1-minute video describing resident training with a cataract surgical simulator on patients' perceptions regarding resident involvement in cataract surgery and to identify factors associated with patient willingness to have cataract surgery performed by a resident.
Design Cross-sectional survey.
Methods An anonymous Likert-style survey was conducted among 430 consecutive adult patients who presented for eye examination at the Penn State Health Eye Center. The survey included questions regarding demographics, understanding of the medical training hierarchy, and patient willingness to have a resident perform their cataract surgery. There were six questions regarding patient willingness to have residents perform their cataract surgery and the second question in this set informs the patient that residents are supervised by an experienced cataract surgeon. Patients were randomly assigned to one of two groups: patients in Group 1 completed the survey only, while patients in Group 2 watched a 1-minute video describing resident training with a cataract surgical simulator prior to completing the survey.
Results Four hundred fourteen of the 430 patients (96.3%) completed the survey. Overall, 24.7% (n = 102) of respondents expressed willingness to allow an ophthalmology resident to perform their cataract surgery, and that proportion increased to 54.0% (n = 223) if the patient was informed that the resident would be supervised by an experienced cataract surgeon. Patients in Group 2 were twice as likely compared with patients in Group 1 to express willingness to allow an ophthalmology resident to perform their cataract surgery (odds ratio 1.92 [1.18–3.11], p = 0.009).
Conclusions A thorough informed consent process including information regarding attending supervision and a brief video detailing resident training with a cataract surgery simulator may increase patient willingness to allow resident participation in cataract surgery.
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Affiliation(s)
- Zachary C. Landis
- Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania
- Eye Associates of Lancaster, Lancaster, Pennsylvania
| | - John B. Fileta
- Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania
- Eye Associates of Lancaster, Lancaster, Pennsylvania
| | - Allen R. Kunselman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Joseph Sassani
- Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ingrid U. Scott
- Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Lin JC, Yu Z, Scott IU, Greenberg PB. Virtual reality training for cataract surgery operating performance in ophthalmology trainees. Hippokratia 2021. [DOI: 10.1002/14651858.cd014953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- John C Lin
- Program in Liberal Medical Education; Brown University; Providence RI USA
| | - Zane Yu
- The Warren Alpert Medical School; Brown University; Providence Rhode Island USA
| | - Ingrid U Scott
- Ophthalmology and Public Health Sciences; Penn State College of Medicine; State College PA USA
| | - Paul B Greenberg
- Division of Ophthalmology; Warren Alpert Medical School of Brown University; Providence Rhode Island USA
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Global multi-site, prospective analysis of cataract surgery outcomes following ICHOM standards: the European CAT-Community. Graefes Arch Clin Exp Ophthalmol 2021; 259:1897-1905. [PMID: 33855602 DOI: 10.1007/s00417-021-05181-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate in a large sample of patients from 10 different European centers the results of cataract surgery, characterizing the relationship between patient-reported outcomes (PROMs) and clinician-reported outcome measures (CROMs). METHODS Prospective non-interventional multicenter observational descriptive study analyzing the clinical outcomes of a total of 3799 cases undergoing cataract surgery (mean age: 72.7 years). In all cases, the cataract surgery standard developed by the International Consortium for Health Outcomes Measurements (ICHOM) was used to register the clinical data. Three-month postoperative visual acuity and refraction data were considered CROMs, whereas Rasch-calibrated item 2 (RCCQ2) and total Catquest-9SF score (CQ) were considered PROMs. RESULTS Postoperative corrected distance visual acuity (CDVA) was 0.3 logMAR or better in 88.7% (2505/2823) of eyes. Mean differences between preoperative and postoperative RCCQ2 and CQ scores were -3.09 and -2.39, respectively. Visual function improvement with surgery was reported by 91.5% (2163/2364) of patients. Statistically significant, although weak, correlations of postoperative CDVA with postoperative refraction, PROMs, and complications were found (0.133 ≤ r ≤0.289, p < 0.001). A predictive model (R2: 0.254) of postoperative CDVA considering 10 variables was obtained, including preoperative CDVA, different ocular comorbidities, age, gender and intraoperative complications. Likewise, another predictive model (R2: 0.148) of postoperative CQ considering a total of 14 variables was obtained, including additionally preoperative CQ, target refraction and previous surgeries. CONCLUSIONS Cataract surgery provides an improved functional vision in most of patients although this improvement can be limited by ocular comorbidities and complications. The relationship between PROMs and CROMs is multifactorial and complex.
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21
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Cleland SC, Knoch DW, Larson JC. Outcomes of Femtosecond Laser Assisted Cataract Surgery Performed by Resident and Attending Surgeons. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2021. [DOI: 10.1055/s-0041-1725582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Abstract
Objective The study aimed to evaluate the safety and efficacy of resident surgeons performing femtosecond laser assisted cataract surgery (FLACS).
Methods A retrospective chart review was conducted at the University of Wisconsin-Madison from postgraduate year four residents performing FLACS between 2017 and 2019. Data were also collected from residents performing manual cataract surgery, and attending surgeons performing FLACS for comparison. Recorded data included patient demographics, pre- and postoperative visual acuity, pre- and postoperative spherical equivalent, nuclear sclerotic cataract grade, ocular and systemic comorbidities, intraocular lens, duration of surgery, cumulative dissipated energy (CDE), and intraoperative and postoperative complications.
Results A total of 90 cases were reviewed with 30 resident manual cases, 30 resident FLACS cases, and 30 attending FLACS cases. Resident manual (25.5 ± 6.8 minutes) and resident FLACS (17.5 ± 7.1 minutes) cases took a significantly longer time to complete compared with attending FLACS cases (13.6 ± 4.4 minutes; p < 0.001). There was higher CDE in resident FLACS and resident manual cases compared with attending FLACS cases, but the difference was not statistically significant (p = 0.06). Postoperative visual acuity was not statistically different at 1-day and 1-month after surgery among the three groups. Resident FLACS complications, which included one case requiring an intraoperative suture to close the wound, two cases with intraoperative corneal abrasions, two cases with postoperative ocular hypertension, and one case with cystoid macular edema, were not significantly greater than attending FLACS complications (p = 0.30).
Conclusion The FLACS performed by resident surgeons had comparable visual acuity outcomes to FLACS performed by attending surgeons, and to manual cataract surgery performed by resident surgeons. However, resident FLACS cases took significantly longer time to complete, and they were associated with a higher CDE and minor complication rate compared with attending FLACS cases. Introducing advanced technologies into surgical training curricula improves resident preparedness for independent practice, and this study suggests FLACS can be incorporated safely and effectively into resident education.
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Affiliation(s)
- Spencer C. Cleland
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Daniel W. Knoch
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jennifer C. Larson
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin
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Bartley GB. Verifying Surgical Competence: Our Fiduciary Responsibility. Ophthalmology 2020; 127:997-999. [PMID: 32703391 DOI: 10.1016/j.ophtha.2020.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/18/2020] [Indexed: 10/23/2022] Open
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Nishiguchi F, Ishikawa H, Amaki J, Komuku Y, Kimura A, Gomi F. Effects of cataract surgery in Japanese patients with neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2020; 259:1145-1151. [PMID: 33205241 PMCID: PMC8102274 DOI: 10.1007/s00417-020-05015-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To investigate the effects of cataract surgery in Japanese patients with neovascular age-related macular degeneration (nAMD). Methods The primary endpoint in this prospective, observational study was patient satisfaction at 6 months after cataract surgery in patients with nAMD. Secondary endpoints comprised changes in best-corrected visual acuity (BCVA), M-chart score, central retinal thickness (CRT), AMD status, and number of AMD treatments. All examinations were performed before surgery, and at 1, 3, and 6 months postoperatively. Results Fifty patients (52 eyes) were included in this study (32 men; mean age, 76.1 ± 7.1 years). Thirty-nine patients (75.0%) reported satisfaction with cataract surgery. BCVA significantly improved at all postoperative timepoints (all p < 0.0001), whereas differences in M-chart scores were not statistically significant. The number of eyes with BCVA ≤ 0.3 logarithm of the minimum angle of resolution (logMAR) increased from 21 to 38; however, CRT did not change. The number of AMD treatments did not change during follow-up. All questionnaire scores showed postoperative improvement. Univariate and multivariate analyses revealed that final BCVA ≤ 0.3 logMAR was significantly associated with patient satisfaction. Conclusion Cataract surgery significantly improved vision in Japanese patients with nAMD, without affecting AMD status. Patients were satisfied with cataract surgery, especially with respect to improvement of distance vision.
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Affiliation(s)
- Fumi Nishiguchi
- Department of Ophthalmology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hiroto Ishikawa
- Department of Ophthalmology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Junichi Amaki
- Department of Ophthalmology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yuki Komuku
- Department of Ophthalmology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Akiko Kimura
- Department of Ophthalmology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
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Chung H, Sanders E, Rocha G, Bhamra J. Canadian Opinions on Refractive Surgery and Approaches to Presbyopia Correction. J Curr Ophthalmol 2020; 32:99-102. [PMID: 32510021 PMCID: PMC7265273 DOI: 10.4103/joco.joco_50_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/16/2019] [Accepted: 10/23/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose: To explore the opinions of Canadian ophthalmologists on refractive and presbyopia-correcting surgeries. Methods: We distributed an online survey to the Canadian Ophthalmological Society members, covering laser refractive surgery (LRS), femtosecond laser-assisted cataract surgery (FLACS), lenticular refractive surgery (lenRS) that includes cataract refractive surgery (CRS) with premium intraocular lens (IOL) implantation, and presbyopia correction. Results: There were 68 (7.6%) total respondents. Most respondents would not consider LRS (62.5%) nor FLACS (73.9%) for themselves. Male sex and performance of LRS or FLACS was significantly associated with consideration of these procedures for self. Most respondents (59.3%) would consider lenRS for themselves. The top method of personal presbyopia correction was spectacles, chosen by 52.5%. Conclusions: When surveying the wide body of Canadian ophthalmologists, most respondents preferred spectacle correction of presbyopia and would consider lenRS, but not LRS or FLACS for themselves. Surgeons performing these procedures were more likely to consider them for self.
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Affiliation(s)
| | - Emi Sanders
- Section of Ophthalmology, Department of Surgery, University of Calgary, Calgary, Canada
| | - Guillermo Rocha
- Department of Ophthalmology, University of Manitoba, Winnipeg, Canada
| | - Jamie Bhamra
- Vector Eye Centre, Calgary, Canada.,Section of Ophthalmology, Department of Surgery, University of Calgary, Calgary, Canada
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Dean W, Gichuhi S, Buchan J, Matende I, Graham R, Kim M, Arunga S, Makupa W, Cook C, Visser L, Burton M. Survey of ophthalmologists-in-training in Eastern, Central and Southern Africa: A regional focus on ophthalmic surgical education. Wellcome Open Res 2019; 4:187. [PMID: 31886411 PMCID: PMC6913214 DOI: 10.12688/wellcomeopenres.15580.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 11/20/2022] Open
Abstract
Background: There are 2.7 ophthalmologists per million population in sub-Saharan Africa, and a need to train more. We sought to analyse current surgical training practice and experience of ophthalmologists to inform planning of training in Eastern, Central and Southern Africa. Methods: This was a cross-sectional survey. Potential participants included all current trainee and recent graduate ophthalmologists in the Eastern, Central and Southern African region. A link to a web-based questionnaire was sent to all heads of eye departments and training programme directors of ophthalmology training institutions in Eastern, Central and Southern Africa, who forwarded to all their trainees and recent graduates. Main outcome measures were quantitative and qualitative survey responses. Results: Responses were obtained from 124 (52%) trainees in the region. Overall level of satisfaction with ophthalmology training programmes was rated as 'somewhat satisfied' or 'very satisfied' by 72%. Most frequent intended career choice was general ophthalmology, with >75% planning to work in their home country post-graduation. A quarter stated a desire to mainly work in private practice. Only 28% of junior (first and second year) trainees felt surgically confident in manual small incision cataract surgery (SICS); this increased to 84% among senior trainees and recent graduates. The median number of cataract surgeries performed by junior trainees was zero. 57% of senior trainees were confident in performing an anterior vitrectomy. Only 29% of senior trainees and 64% of recent graduates were confident in trabeculectomy. The mean number of cataract procedures performed by senior trainees was 84 SICS (median 58) and 101 phacoemulsification (median 0). Conclusion: Satisfaction with post-graduate ophthalmology training in the region was fair. Most junior trainees experience limited cataract surgical training in the first two years. Focused efforts on certain aspects of surgical education should be made to ensure adequate opportunities are offered earlier on in ophthalmology training.
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Affiliation(s)
- William Dean
- International Centre for Eye Health (ICEH), Clinical Research Department Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E7HT, UK
- Department of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - John Buchan
- International Centre for Eye Health (ICEH), Clinical Research Department Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E7HT, UK
| | - Ibrahim Matende
- College of Ophthalmology of Eastern Central & Southern Africa, Nairobi, Kenya
| | - Ronnie Graham
- International Agency for the Prevention of Blindness, Durban, South Africa
| | - Min Kim
- Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Simon Arunga
- International Centre for Eye Health (ICEH), Clinical Research Department Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E7HT, UK
| | | | - Colin Cook
- Department of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Linda Visser
- Department of Ophthalmology, University of KwaZulu-Natal, Durban, South Africa
| | - Matthew Burton
- International Centre for Eye Health (ICEH), Clinical Research Department Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E7HT, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Shimazaki J, Tomida D, Yamaguchi T, Satake Y. Descemet stripping automated endothelial keratoplasty performed by trainees. Jpn J Ophthalmol 2019; 63:158-164. [PMID: 30783938 DOI: 10.1007/s10384-019-00652-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/07/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the surgical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) performed by trainees. STUDY DESIGN Retrospective, case control comparative study. METHODS This study compared cases performed by trainees with those performed by an experienced surgeon. First 10 cases of DSAEK performed by trainees with more than 6 months follow-up periods were recruited. The surgical outcomes of DSAEK performed by the trainees (Trainee group) were compared with disease-matched pairs of cases performed by an experienced surgeon (Experienced group). Graft clarity, best spectacle-corrected visual acuity, corneal endothelial cell density, and incidence of intra- or post-operative complications were studied. RESULTS Forty-one pairs were recruited. The graft clarity rate was not different between the Trainee and Experienced groups, with 95.1% and 97.6%, respectively, maintaining clear grafts at 12 months postoperatively. Trainee best spectacle corrected visual acuity was significantly worse at 6 and 12 months postoperatively compared with the Experienced group, and percent decreases in corneal endothelial density was more in the Trainee group at 3 months following surgery (P = 0.0029). While intra- or late post-operative complication rates were similar in both groups, incidences of early post-operative complications such as double chamber formation or pupillary block were observed more frequently in the Trainee group than in the Experienced group (P = 0.049). CONCLUSION DSAEK can be performed relatively safely by training physicians with careful preparation and supervision by attending physicians. However, careful case selection and education on management of air injected in the anterior chamber seemed to be a key to long-term success.
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Affiliation(s)
- Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan.
| | - Daisuke Tomida
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Yoshiyuki Satake
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
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Borboli-Gerogiannis S, Jeng-Miller KW, Koulisis N, Moustafa GA, Chang KK, Chen SH, Gardiner MF, Greenstein SH, Luo Z, Chen TC, Loewenstein JI, Miller JW, Haviland MJ, Kloek CE. A Comprehensive Surgical Curriculum Reduced Intra-operative Complication Rates of Resident-performed Cataract Surgeries. JOURNAL OF SURGICAL EDUCATION 2019; 76:150-157. [PMID: 30131282 DOI: 10.1016/j.jsurg.2018.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/07/2018] [Accepted: 07/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate the impact of a comprehensive cataract surgery curriculum on the incidence of intraoperative complications. DESIGN We retrospectively compared the total number of cataract surgeries that the residents performed in all of the teaching sites, and the incidences of intraoperative complications (anterior capsule tear, posterior capsule rent, vitreous loss, anterior vitrectomy, zonular dialysis, iris trauma, hemorrhage, dropped lens fragment, corneal wound burn, incorrect intraocular lens) for the surgeries performed at Massachusetts Eye & Ear by residents in the pre-intervention group (residents graduating in 2004 and 2005), before the implementation of a surgical curriculum, and the residents in the post-intervention group (residents graduating in 2014 and 2015). SETTING Ophthalmology residency program at a major academic institution. PARTICIPANTS Residents graduating in 2004, 2005, 2014, and 2015. RESULTS We reviewed 4373 charts. 2086 of those surgeries were performed at Massachusetts Eye & Ear. The incidence of posterior capsule rent/vitreous loss/anterior vitrectomy was lower in the post-intervention group (1.4% versus 7.7%, p < 0.0001). Other complications were also lower in the post-intervention group. CONCLUSIONS Implementation of a comprehensive cataract surgery curriculum focusing on pre-operative, intra-operative and post-operative interventions, with an emphasis on patient outcomes resulted in a decrease in the rate of intraoperative complications.
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Affiliation(s)
- Sheila Borboli-Gerogiannis
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - Karen W Jeng-Miller
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - Nicole Koulisis
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Giannis A Moustafa
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - Kenneth K Chang
- University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii.
| | - Sherleen H Chen
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - Matthew F Gardiner
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - Scott H Greenstein
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - Zhonghui Luo
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - Teresa C Chen
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - John I Loewenstein
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - Joan W Miller
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - Miriam J Haviland
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
| | - Carolyn E Kloek
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
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Wet Lab-Based Cataract Surgery Training Curriculum for the PGY 2/PGY 3 Ophthalmology Resident. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10782. [PMID: 30800982 PMCID: PMC6342368 DOI: 10.15766/mep_2374-8265.10782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Studies have shown that structured cataract surgery training curricula are beneficial for resident surgeons-in-training, yet nearly one-third of US training programs do not have one, and public dissemination of said curricula are lacking. Methods We created a microsurgical simulation center and accompanying structured training curriculum. Weekly lectures focused on the steps of cataract surgery, variations on technique, and complications. Each didactic was followed by a 1.5- to 2-hour time block with faculty supervision in the wet lab. Finally, to demonstrate proficiency, residents submitted a recorded video illustrating their competency within 1 week of the lecture. We reviewed videos and provided written feedback via a standardized form. Curriculum effectiveness was evaluated through formative feedback on the course itself and complication rates for resident-performed cataract surgery before and after implementation of the curriculum. Results The course was implemented in 4 consecutive academic years, allowing time for nine junior residents to participate in the course at least once before operating as a senior. The incidence of posterior capsule tears for senior residents decreased from 3.07% in the 4 years preceding curriculum implementation to 1.13% for the senior residents who completed the course at least once as juniors (p = .0571). Supervised wet lab sessions and submitted videos allowed faculty to identify surgically struggling residents early. Discussion Implementation of a cataract surgery training curriculum for junior ophthalmology residents provides a safe and effective environment to practice surgical techniques. Such a curriculum may decrease the complication rates of beginner surgeons.
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Ellis EM, Lee JE, Saunders L, Haw WW, Granet DB, Heichel CW. Complication rates of resident-performed cataract surgery: Impact of early introduction of cataract surgery training. J Cataract Refract Surg 2018; 44:1109-1115. [PMID: 30078539 DOI: 10.1016/j.jcrs.2018.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/05/2018] [Accepted: 06/09/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine the effect of the early introduction of cataract surgery training on the complication rates of resident-performed cataract surgery. SETTING University of California San Diego, San Diego, California, USA. DESIGN Retrospective case series. METHODS Two classes of ophthalmology residents were examined, one class with a late introduction of cataract surgery and one with an early introduction of cataract surgery. All cataract cases in which residents acted as primary surgeon were included. Patient charts were reviewed to collect data on patient characteristics, surgical details, and intraoperative and postoperative complications. RESULTS The late-introduction cohort comprised 3 residents who performed 540 cataract cases, all during their final year of residency. The early-introduction cohort comprised 4 residents who performed 780 cataract cases beginning in the first year of residency. The late-introduction cohort had higher rates of major intraoperative complications than the early-introduction cohort (8.5% versus 3.1%) and of anterior vitrectomy (7.6% versus 2.1%) (both P < .001). Examination of the anterior vitrectomy rate as a function of experience showed the early-introduction cohort had a stable anterior vitrectomy rate of 1% to 2% throughout training, while the late-introduction cohort had a peak anterior vitrectomy rate of 12% at approximately case 20. Multivariable regression analysis showed the early-introduction cohort was independently associated with a lower rate of anterior vitrectomy (hazard ratio, 0.49; 95% confidence interval, 0.36-0.66) after adjusting for differences in patient characteristics and surgical complexity. CONCLUSIONS Early introduction of cataract surgery training significantly decreased the rate of major intraoperative complications, specifically anterior vitrectomy, in resident-performed cataract surgeries.
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Affiliation(s)
- Erika M Ellis
- From the Bascom Palmer Eye Institute (Ellis), Miller School of Medicine, University of Miami, Miami, Florida, and Shiley Eye Institute (Saunders, Lee, Haw, Heichel) and Ratner Children's Eye Center of the Shiley Eye Institute (Granet), University of California San Diego, San Diego, California, USA
| | - Jeffrey E Lee
- From the Bascom Palmer Eye Institute (Ellis), Miller School of Medicine, University of Miami, Miami, Florida, and Shiley Eye Institute (Saunders, Lee, Haw, Heichel) and Ratner Children's Eye Center of the Shiley Eye Institute (Granet), University of California San Diego, San Diego, California, USA
| | - Luke Saunders
- From the Bascom Palmer Eye Institute (Ellis), Miller School of Medicine, University of Miami, Miami, Florida, and Shiley Eye Institute (Saunders, Lee, Haw, Heichel) and Ratner Children's Eye Center of the Shiley Eye Institute (Granet), University of California San Diego, San Diego, California, USA
| | - Weldon W Haw
- From the Bascom Palmer Eye Institute (Ellis), Miller School of Medicine, University of Miami, Miami, Florida, and Shiley Eye Institute (Saunders, Lee, Haw, Heichel) and Ratner Children's Eye Center of the Shiley Eye Institute (Granet), University of California San Diego, San Diego, California, USA
| | - David B Granet
- From the Bascom Palmer Eye Institute (Ellis), Miller School of Medicine, University of Miami, Miami, Florida, and Shiley Eye Institute (Saunders, Lee, Haw, Heichel) and Ratner Children's Eye Center of the Shiley Eye Institute (Granet), University of California San Diego, San Diego, California, USA
| | - Chris W Heichel
- From the Bascom Palmer Eye Institute (Ellis), Miller School of Medicine, University of Miami, Miami, Florida, and Shiley Eye Institute (Saunders, Lee, Haw, Heichel) and Ratner Children's Eye Center of the Shiley Eye Institute (Granet), University of California San Diego, San Diego, California, USA.
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Virtual eye surgery training in ophthalmic graduate medical education. Can J Ophthalmol 2018; 53:e218-e220. [PMID: 30502995 DOI: 10.1016/j.jcjo.2018.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 02/27/2018] [Accepted: 03/05/2018] [Indexed: 11/24/2022]
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Lin ZN, Chen J, Zhang Q, Li Q, Cai MY, Yang H, Cui HP. The 100 most influential papers about cataract surgery: a bibliometric analysis. Int J Ophthalmol 2017; 10:1586-1591. [PMID: 29062780 DOI: 10.18240/ijo.2017.10.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/17/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To identify the 100 most cited papers in cataract surgery, we performed a comprehensive bibliometric analysis basing on the literature search on the Thomson Reuters Web of Knowledge. METHODS The number of citations, including the total citations, latest 5y citations and average citation number per year (ACY), authorship, year of publication, major topics, journal of publication, country and institution of origin of each paper were recorded and then analyzed. Pearson's correlation analysis was conducted to evaluate the correlation between the published year and the number of citations. The correlation between journal's impact factor (IF) and number of citations was assessed as well. RESULTS The most cited paper was the classic paper done by the European Society of Cataract & Refractive Surgeons (ESCRS) group. This paper focused on the topic of endophthalmitis. Not only the most cited papers originated from the USA, but also some American institutions like Johns Hopkins University, Harvard Medical School, etc. had the most citations. Pearson's correlation analysis indicated that the latest 5y citations and ACY were significantly related with the published year (5y citations: r=0.615, P<0.001; ACY: r=0.657, P<0.001), whereas no association between the total number of citations and published year was found (r=0.045). Moreover, the IFs of journals were found to have no significant effect on the number of total citations. CONCLUSION To our knowledge, this is the first study on the most influential papers in cataract surgery after a comprehensive research of relevant literatures. The present work may provide us concise information concerning the development history of cataract surgery over the past 66y.
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Affiliation(s)
- Ze-Nan Lin
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China.,Centre for Ophthalmology, Eberhard-Karls University of Tuebingen, Tuebingen 72076, Germany
| | - Jie Chen
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Qi Zhang
- Department of Neurosurgery, Eberhard-Karls University of Tuebingen, Tuebingen 72076, Germany
| | - Qian Li
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Min-Yun Cai
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Hai Yang
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Hong-Ping Cui
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
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