New steps in the training of young ophthalmologists
Phacoemulsification e lenses intraocular (IOL) have marked a revolution in surgery of the cataractdecades ago: in 1967 Charles D. Kelman performed the first phacoemulsification, while Harold Ridley successfully implanted the first IOL as early as November 1949.
These two radical innovations have now become standard in cataract treatment, at least in the developed world, and thus young eye surgeons in training have a considerable advantage over previous generations, who had to develop operating techniques from scratch and learn through trial and error.
Moreover, with the advent of the Internet, YouYube and the proliferation of courses and wetlabs, the training offer has grown exponentially.
Roberto Bellucci, director of the Verona Eye Clinic and president of ESCRSrecently stated in an interview with EuroTimes "When I started my apprenticeship as a cataract surgeon, there were no videos, VHS or other recordings available. The only way to learn was to stand behind a surgeon and learn the technique through the operating microscope. Now the spread of knowledge is much faster'. He also added that "Today, teaching how to operate has become a little less 'surgical' and a little more technical. It is now essential to explain how a phacoemulsifier works and where to find the best machines. Nowadays you have to be a bit like a plumber to understand the fluidics, piping and general mechanics of a phacoemulsifier."
"Before the advent of sutureless techniques, cataract surgery was more like other types of surgery because it involved incisions that had to be sutured. Now there is no need to learn how to close an eye. Therefore, the transition to other types of ophthalmic surgerysuch as the corneal transplants, penetrating and anterior lamellar keratoplasty is much more difficult for young ophthalmologists than it used to be."
Modern tools for becoming an ophthalmologist
To respond to these new problems, scientific societies such as ESCRS, on the international level, and AICCER, on the Italian level, are trying to set up training courses to help young eye surgeons approach surgeries involving large incisions and the need for sutures.
The starting point for becoming an ophthalmologist is undoubtedly a good knowledge of the 'fundamentals', i.e. everything that underlies the surgical act. In this context, the use of surgical simulators (such as the EyeSi system), which allow practice over a prolonged period of time and provide direct feedback on microsurgical performance, can be very useful. The main problem is that they are rather expensive.
The next step is to become familiar with the equipment and machinery used in the surgical act in the present day: some practice with phaco and gloves on tennis balls might be useful before moving on to live patients.
Another critical point in the pathway to becoming an ophthalmologist might be the sequence of learning the surgical procedures: sometimes it is more useful to start the training from the less problematic phases and only then move on to those where the highest rate of complications can occur. This means that one might not follow the chronological sequence of the surgical procedure: surgeons might first learn how to aspirate visco-elastic and only then learn how to implant an IOL.
At this point, the revolutionary contribution of video can be assessed. For every young surgeon, watching the most experienced surgeon, the 'master', has always been essential: video adds to this the possibility of watching without the pressure of live surgery, of re-watching the most delicate steps by rewinding the tape, of following an operation commented step by step.
With these 'training ingredients' one can hope to get the best out of the mix of technological progress and new digital media, always aiming at the best quality of surgical performance for the patient's visual health.
Dr. Carmelo Chines
Direttore responsabile
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