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Doctor, teach thyself
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The privilege of performing surgery on our patients' eyes, and altering their most precious asset, their eyesight, is something we as surgeons earned over a long training period. After training, we continue to cultivate our skill by honing our technique, using as a guide our patients' outcomes as an indicator of which techniques work better and which do not. But how many of us systematically review footage of our surgery with the aim of improving our results?
Teachers of public speaking can attest to the value of recording our voice and listening to it. This introspection gives valuable feedback on the nuances of vocal tone and emphasis. How much more subtlety is there in the art of performing microsurgery inside the eye?
Most of us think of ourselves as fairly experienced surgeons who do not have a great deal to learn in the steps of the surgery we perform as frequently as, say, cataract surgery. Let's not be so sure. Most of us who review recordings of our own surgery are surprised to see how many wasted movements we make. Perfectionists by nature, we ophthalmologists tend to repeat our movements, aiming to make the tissue look perfect before we move on to the next step. Persevering in this manner rarely improves results. Rather, it causes mild but unnecessary tissue trauma, and probably only prolongs healing. During irrigation and aspiration, for example, we want to be meticulous in cortex and viscoelastic removal, but all too often we spend too much time running balanced salt solution through the eye. This results in endothelial cell loss and attendant postoperative corneal edema that is simply unnecessary.
Our profession is blessed with many fine teachers of surgical technique, but many of us may find our best teachers to be ourselves, armed with a VCR and an ego that's at least as resistant to trauma as the tissues we treat.
See Dr. Hovanesian share more expert insight live at Hawaiian Eye 2012, to be held January 15-20, 2012 at the Grand Wailea Resort & Spa in Wailea, Maui. Learn more at OSNHawaiianEye.com.