CATARACT SURGERY FUNDAMENTALS

Cataract surgery – it's the procedure that unites nearly all eye doctors, and it's the primary surgical task to master for every young ophthalmologist. Every year, trainees across the world embark on a process of learning that will eventually allow them to operate independently. The learning process is complex, as the procedure itself is deceptively difficult. Becoming proficient usually takes several years, extending well into our professional lives after we have completed our training. Experienced surgeons might take phacoemulsification skill for granted. After thousands of operations, the steps and the logic behind them, have become second nature. But residents, having diagnosed the many possible complications during call in the emergency room – capsular rupture, dropped nucleus, endophthalmitis – are understandably anxious when first offered the chance to introduce sharp or aspirating instruments into an eye. Indeed, the old saying, 'See one, do one, teach one,' does not seem to apply for cataract surgery as it does for the treatment of a chalazion. Most residents in surgical programmes will see 100 or more expertly performed procedures before being handed a scalpel. Then, they'll be expected to perform a similar amount on their own before earning the title of ophthalmologist. Teaching comes much later, and then only to a select few who have truly mastered the procedure. So how does one get started? The quick steps performed by mentors move so smoothly and look so easy that a trainee might miss a great deal of the sequence, precision and detail. That is, if they're not prepared ahead of time with a basic mental map of the steps: What happens? When? Why? And it's not only what's going on inside the eye that counts. How to set up and use the equipment – the operating microscope and the phaco machine and their respective foot pedals – is not self-evident, nor is the proper preoperative preparation of the patient. This is where 'Phaco Fundamentals: A Guide for Trainee Ophthalmic Surgeons' comes in. Written by Matthew Anderson and Jeremy Butcher, this book guides the reader through every stage of a cataract operation in an extremely simple, step-bystep manner.

Covering the material in under 100 pages, with well over 100 intraoperative photographs and simple drawings, the book treats each distinct step in its own chapter and is intended to equip the trainee with the knowledge required to complete his or her phaco from start to finish. For example, 'The Corneal Section' discusses the keratome, the multiplanar wound, and a few 'helpful points' to remember. 'The Capsulorhexis' introduces the reader to the various instruments available, the technique itself, and how to avoid potential pitfalls, like peripheral extension of the rhexis under the iris. Each of the steps is covered in this manner. The last chapter, 'Final Steps,' reminds us to inform the patient that we are about to remove the speculum, so as to avoid startle, and to make sure that the patient's hair isn't yanked out when removing the drape. Each of the 13 chapters is about eight pages long – enough to cover the main points and get the reader closer to the goal of memorising and understanding the basics without getting bogged down by minutiae. Thankfully, the authors avoid data, percentages, precise measurements, and other details unlikely to be of immediate use during the procedure itself. Further, theoretical and philosophical considerations are left for other texts, as are anatomical facts and figures. The authors assume that the reader has the knowledge expected of those who will be allowed to operate. This book is useful for ophthalmology residents, fellows in the early part of their training, and surgeons responsible for teaching cataract surgery. For the latter group, a review of the very basic steps outlined in this book might give the teacher insight into just how little a beginning surgeon might know. Further, training programmes might be interested in acquiring a few copies as required reading prior to their trainees' surgical rotations.