• Pearls to Prep for Cataract Surgery

    You’ve done a lot to get to this point. And as you’ve come to learn, diligence and preparation will serve you well as you embark on the steep and rewarding learning curve of cataract surgery.

    These tips will help you build your surgical skillset.

    1. Know your instruments and the steps of the surgery

    During your first few cases, it can feel like a lot is happening all at once. Take control of the situation by mentally mastering the steps ahead and knowing which instruments to ask for next. The Academy’s Basic Techniques of Ophthalmic Surgery provides a concise list of instruments. As you become more comfortable with the procedure, begin to familiarize yourself with various second instruments and hydrodissection cannulas to figure out what works best for you. Don’t become stagnant in your learning. Early on, it’s important to be consistent with your tools and settings to develop muscle memory.

    2. Practice in the wet lab

    Practice at your wet lab early on in your learning curve. If your training program has a virtual simulator, try to work through as many of the high-yield training modules as possible before your first few cases. The capsulorhexis modules are particularly helpful. These training modules have also been shown to improve dexterity in your nondominant hand. Doing daily activities with your nondominant hand (e.g., brushing your teeth and your hair) can also help.

    Model eyes can also be useful for practicing incisions, capsulorhexis, nuclear disassembly, using both hands and lens insertion.

    3. Get comfortable with the microscope and pedals

    Few things we’ve done in the past have required using both hands and feet at the same time. Futzing with the microscope and pedal during surgery can create unnecessary stress. So learn how to adjust the magnification and fine focus with your pedal as soon as possible. Also practice the foot pedal positioning differences between irrigation, aspiration and phacoemulsification.

    4. Watch lots of videos, especially your own

    There are so many lessons to be learned from watching how things went in your cases. Make sure to record and review your videos regularly, taking time to pause and think about what made the case flow or what made a certain step particularly tricky. It’s an added bonus if you can review these cases with a surgical mentor. Your mentor can help evaluate your cases and identify what steps you can work on in and outside of the operating room.

    It’s also helpful to review the plethora of resources available online. Make sure to check out Dr. Uday Devgan’s Cataract Coach website and YouTube channel. He has curated a beginner’s playlist of some of the most critical steps of cataract surgery. I highly recommend the videos that show multiple iterations of incision creation and capsulorhexis formation.

    5. Review helpful handbooks like Cataract Surgery for Greenhorns

    I found Dr. Tom Oetting’s manual to be very helpful when I first started learning cataract surgery. Not only does he walk you through the basics of phacoemulsification, but he also highlights how to talk to your patients about surgery and what they can expect postoperatively. He also highlights potential intraoperative and postoperative complications and how to manage them. In addition, Dr. Oetting has created a set of benchmarks that help you gauge where your skillset could be by a certain number of cases.

    Another helpful reading resource is Dr. Bonnie Henderson’s Essentials of Cataract Surgery, which has great diagrams showing how to employ different surgical techniques.

    Learning cataract surgery is exciting, but it requires deliberate practice, review and a commitment to continually improve. These are great starter guides. You will soon learn what works best for you!

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    Cherie A. Fathy, MDCherie A. Fathy, MD, joined the YO Info editorial board in 2022. She completed her residency at Wills Eye Hospital in Philadelphia and is finishing her cornea fellowship in 2022 at Wilmer Eye Institute at Johns Hopkins Hospital in Baltimore.