(1)
St. Johns, FL, USA
(2)
Helen Keller Foundation for Research and Education, International Society of Ocular Trauma, Birmingham, AL, USA
(3)
Consultant and Vitreoretinal Surgeon, Milos Eye Hospital, Belgrade, Serbia
(4)
Consultant and Vitreoretinal Surgeon, Zagórskiego Eye Hospital, Cracow, Poland
The simplified answer is: it primarily depends on your personality. Most people prefer living a life that is mostly a series of routine activities and feel uncomfortable if they are constantly exposed to challenges, especially if these vary in nature and severity. Such people would have an unhappy life as a VR surgeon.1 Table 1.1 compares the life of the cataract surgeon with that of the VR surgeon.
Table 1.1
Life as a cataract vs as a VR surgeon*
Variable | Cataract surgeon | VR surgeon | Comment |
|---|---|---|---|
Learning curve | Moderate | Very steep | For a VR surgeon the learning process is intense and it remains forever so |
Sleepless nights before or after surgery | Almost nevera | Occasionally | Preoperatively because the surgeon is not sure what the best surgical approach would be Postoperatively because the surgeon now knows he made the wrong choice and it resulted in an irreversibly poor outcome |
Difficulty in preoperative decision-making | Minimal | Moderate to extreme | For the cataract surgeon, the diagnosis brings an almost automatic solution, phaco and IOL implantation, and the timing is also obvious: as soon as feasible. For the VR surgeon, this can raise extremely difficult questions; just think about a one–eyed patient who has retinitis pigmentosa and develops an EMP. If something goes wrong during surgery, the patient instantly loses (some) central vision in an eye that is already losing its visual field; then there is the risk of postoperative complications. Conversely, if surgery is not done, the central vision will gradually and irreversibly decrease |
Consequences if the preoperative decision-making was erroneous | None to minimal | None to extreme | Just think of a patient with an injury that has a high risk of endophthalmitis; you decide to do early PPV but a catastrophic ECH occurs intraoperatively |
Physical challenge intraoperatively | Minimal; mainly determined by how many cases the surgeon decides to perform on a given day | Can be significant | My longest case (TKP–PPV for a severe injury in a young boy) lasted 6 h and 23 min |
Mental challenge intraoperatively | Moderate | Moderate to intense | During cataract surgery the need to make a unique, major decision relatively rarely emerges, but in certain instances real challenges do exist (children, pseudoexfoliation etc.). In VR surgery, even in “easy” cases (VH, see Sect. 62.1), many decisions are required, and some of them, if they prove to have been wrong, result in irreversibly negative consequences |
Difficulty in intraoperative decision-making | Minimal to moderate | Minimal to severe | Cataract surgery has to a large extent been standardized. The inter-case variability is typically limited, and even if the tissue reacts differently to that expected, the solution is usually a readily available one. Even in an “easy” case, the VR surgeon must make several decisions that are individualized to that particular patient/eyeball. In more difficult cases the number of decisions can be almost infinite |
Tissue reaction to the surgeon’s action | Typically as expected | As expected or very different | The nucleus may be as soft as predicted or much harder. During vitreoretinal separation the retina may prove as resistant to traction as assumed – or it may tear at the weakest traction force |
Consequences if the intraoperative decision-making was erroneous | Minimal to moderateb | Minimal to extreme | Certain errors can easily be corrected (an equatorial retinal tear has been caused during too forceful PVD); others can result in irreversible loss of vision (tearing the fovea during EMP removal)
 Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
Get Clinical Tree app for offline access
|