While there are many excellent courses, articles, and textbooks available concerning vitreoretinal surgery, improvement in judgment and surgical skills must principally come about by self-education. The complexity of high-technology vitreous surgery on high-risk patients demands a continued assessment of surgical and biologic results. Vitreous surgery requires an excellent training in microsurgery and retinal diseases. Eye bank eyes, porcine eyes, and molded rubber practice eyes can be used for surgical practice (1–6). It is simply poor judgment to begin vitreous surgery or a new technique on the human patient without sufficient practice. After reading the available literature, visiting other surgeons, and attending appropriate courses, progress will be made in the laboratory. When sufficient competency is obtained in the laboratory, the beginning surgeon should assemble the disposables and equipment required for simulated surgery. Simulator technology has improved, gaining substantial fidelity in recent years, and has the advantages that disease states and intraoperative complications can be simulated. The EyeSi simulator has an excellent vitreoretinal module and is highly recommended. Regardless of the presence of other vitreous surgeons at the same institution, it is the responsibility of the beginning surgeon to go through this practice surgery approach. It is absolutely the responsibility of each surgeon to make certain that all equipment is available and functioning. Unfortunately, many surgeons fall into the trap of placing this responsibility upon technicians, nurses, and ancillary personnel. Practice surgery in the actual operating room should be repeated on the days preceding vitreous surgery if the case in question has not been approached before or the procedures are done infrequently.

The great complexity of vitreoretinal surgery requires an honest assessment of the surgeon’s own capabilities. It is simply inadequate to perform vitrectomy without stereopsis. There are many areas of medicine that are less demanding in the requirements for stereopsis, and the surgeon should not perform vitreous surgery without stereopsis. Red-green color blindness is a major handicap because it makes the diagnosis of iris neovascularization, small retina breaks, and the regression of neovascularization much more difficult to see. It is even important to attempt an assessment of one’s temperament. Vitreous surgery requires a calm but rapid and efficient approach. A surgeon who becomes very tense and inefficient in times of surgical stress has no place in vitreous surgery. A person so compulsive and rigid that necessary changes in the game plan produce overwhelming stress probably should not be performing vitreous surgery. Although ego and economic factors unfortunately influence some surgeons’ decisions, the pleasure is short lived if the results are poor, resulting in a damaged and unhappy patient and possibly a lawsuit. It therefore becomes important to look realistically at the demands for vitreous surgery in the individual’s practice, with an intent to determine if certain procedures can be done frequently enough to attain sufficient surgical skill.

OUTCOMES ANALYSIS

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