Stress during cataract surgery depends on level of experience

April 24, 2022

1 minute read


Grosel T. Attending to stress levels during stages of cataract surgery. Presented at: American Society of Cataract and Refractive Surgery meeting; April 22-26, 2022; Washington.

Disclosures: Grosel does not report any relevant financial information.

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WASHINGTON — Stress levels during cataract surgery in a teaching setting depend on the experience of the resident as well as the assistant, according to a study.

Timothy W. Grosel, MD, said cataract surgery can be stressful for beginners, but becomes easier as surgeons gain more experience during residency.

Timothy W. Grosel

“Supervising cataract surgery as a resident can be even more stressful,” he told the American Society of Cataract and Refractive Surgery meeting. “Assistants typically look at the lateral field and have no real access to the operating field or the inside of the eye.”

Grosel said he and his colleagues sought to determine how present stress levels change during surgery and how they may differ based on residents’ experience levels, as well as their own experience.

The study included 13 residents and six assistants and included 549 surgeries. Researchers used heart rate as a surrogate for stress by strapping a Bluetooth device to the chests of surgeons and assistants during surgery. They combined this data with a video to divide each surgery into eight steps: incision, continuous curvilinear capsulorrhexis, hydrodissection, core disassembly, quadrant removal, cortical cleaning, IOL insertion and closure.

Grosel and his colleagues found that the stages with the highest average heart rates were core disassembly and quadrant removal. Participants had lower average heart rates at all stages of the procedure compared to residents. However, the difference was only significant for the first six steps.

Participants with more than 10 years of experience had significantly lower heart rates for incision, capsulorrhexis, core disassembly, quadrant ablation, cortical cleaning, and closure steps compared to participants with 5 years of experience or less.

Grosel said the participants’ average heart rate decreased as the residents’ experience with the cases increased. However, it started to increase again once residents reached 250-299 experience cases.

“At this stage of training, residents are more comfortable with cataract surgery,” he said. “They’ve developed their own style, and maybe the participants don’t feel like they have as much influence on how the residents work.”

Grosel said the results could be used to guide participants when teaching cataract surgery.

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