Online resources for surgical learning a boon for ophthalmology

Video-sharing sites, interactive websites and e-mail lists are valuable tools for eye surgeons.

Uday Devgan

When I was a resident, I remember borrowing VHS tapes of Robert Osher’s Video Journal of Cataract and Refractive Surgery from my faculty mentors and watching the expertly performed surgeries over and over again. With a field as dynamic as ophthalmology, watching videos of ocular surgery was far more helpful than looking at figures or photos in a book. I soon realized that the procedures that looked so elegant and fluid on video were actually quite challenging to perform during surgery.

As ophthalmology evolves, so do our methods of surgical learning. Fast-forward more than a decade and the ophthalmology residents that I teach watch surgical videos streamed right to their mobile phones, which have higher resolutions than my old television with a cathode ray tube. Surgeons are able to review a step-by-step video of a difficult surgery by an expert minutes before performing the same surgery in their own operating room. Videos are such critical components of surgical learning that many new ophthalmology texts now come with DVDs of surgical videos.

Video websites

The first video-sharing website, and still the leader in that category, is www.YouTube.com, which streams more than 500 million videos per day. I have personally uploaded about 40 teaching videos to the site (www.YouTube.com/ceiol) and, surprisingly, these videos have already received a total of 170,000 views from across the world. The limitation of YouTube used to be the resolution, which was lowered in order to achieve faster download speeds. As Internet connectivity and speed have improved, YouTube has since upgraded to higher-resolution video quality.

Ophthalmology-specific websites tend to host high-definition videos that have been edited and recorded with the surgeon’s voice track to provide further instruction. Ocular Surgery News catalogs more than 1,000 ophthalmology videos on its website, www.OSNSuperSite.com, along with an extensive database of articles and lectures. For surgeons who are unable to travel to hear a speaker live at a national meeting, watching a video of their lecture including slides and instructional surgical clips is nearly as good.

YouTube.com, which is openly accessible to all viewers, hosts more than 150 million videos, including more than 5,000 related to cataract surgery. Images: Devgan U

Interactive websites

Surgeons often want more detailed information and instruction pertaining to a specific laser or phaco platform used in their practice, and they would like to interact with colleagues to exchange pearls. Modern-day phaco machines have friendly user interfaces, but it is still up to the surgeon to program the machine with appropriate parameters from a near infinite number of combinations. Particularly for challenging cataract cases, it is helpful to seek the guidance of other surgeons in determining the optimal fluidic and ultrasonic settings, and these websites allow us to do just that.

A great example of this is Bausch + Lomb’s Stellaris Elite User Community, www.StellarisElite.com, which allows surgeons to connect with each other and share experiences, videos, settings, pearls and advice. Surgeon member locations are shown on a map, allowing users to locate colleagues within their geographic area or across the country, and soon across the globe. Among the most useful features is watching a video of a challenging cataract surgery and having a list of the specific fluidic and ultrasound settings as well as the instruments used for that case. More of these focused user communities will emerge as surgeons look to optimize the use of new technologies for ocular surgery.

StellarisElite.com allows surgeons to connect with each other to share surgical videos, experiences, settings, pearls and advice. It is open to all ophthalmologists, but it limits access to non-physicians to allow for a more open discussion and exchange of ideas.

E-mail lists

Another way to connect surgeons so that they can share ideas is via an e-mail list, often called a listserv after the first electronic mailing list software application. In these lists, one e-mail can be sent to the central list and is then forwarded to a variety of people. The Cornea Society administers the Kera-net list, SurgiVision manages the DataLink WaveLight forum for users of that excimer laser, and the American Society of Cataract and Refractive Surgery hosts the EyeSpaceMD e-mail discussion lists.

The e-mail lists can generate a high volume of messages in the user’s inbox because every reply to every post is sent to every reader. Setting up a separate e-mail address or an auto-sorted folder for these mailing lists can help to minimize the barrage of messages. There may be privacy concerns with these e-mail lists, so patient-identifying information should be masked and sound judgment should be used when voicing strong opinions. Remember that these e-mail messages may be forwarded by some of the recipients and that a permanent record is often kept.

Your own videos

I find it helpful to video-record some of my surgical cases so that I can go back and study them later, similar to a professional athlete who watches his performance in a game to study his weaknesses and strengths. Particularly for challenging cases, I recommend studying the videos of others, devising a game plan for your case and then recording your surgery. With a little editing of the video and an overlaid voice track, you will have a great teaching video that can then be uploaded and shared with others. Our world is changing for the better, and I would enjoy the opportunity to watch and learn from your videos, too — but just don’t hand me a VHS tape.

• Uday Devgan, MD, FACS, FRCS (Glasg), is in private practice at Devgan Eye Surgery in Los Angeles, Beverly Hills and Newport Beach, Calif. He is also chief of ophthalmology at Olive View UCLA Medical Center and associate clinical professor at the UCLA School of Medicine. He can be reached at 11600 Wilshire Blvd., Suite 200, Los Angeles, CA 90025; 800-337-1969; fax 310-388-3028; e-mail: devgan@gmail.com; website: www.devganeye.com. Dr. Devgan is a consultant to Bausch + Lomb but has no financial interest in the Stellaris Elite website.