Short Communication - Journal of Clinical Ophthalmology (2022) Ocular infections: Immunology, Pathogenesis and Interventions
Pediatric cataract surgery training and its way forward!
Department of Ophthalmology, Ahalia Foundation Eye Hospital, Palakkad, Kerala, India
- Corresponding Author:
- Dr. Akshay Badakere
Department of Ophthalmology
Ahalia Foundation Eye Hospital
E-mail: [email protected]
Received: 02-Feb-2022, Manuscript No. AACOVS-22-55892; Editor assigned: 04-Feb-2022, PreQC No. AACOVS-22-55892 (PQ); Reviewed: 18-Feb-2022, QC No. AACOVS-22-55892; Revised: 22-Feb-2022, Manuscript No. AACOVS-22-55892 (R); Published: 01-Mar-2022, DOI: 10.35841/aacovs.22.6.525-526.
Citation: Badakere A. Pediatric cataract surgery training and its way forward! J Clin Ophthalmol. 2022;6(S7):522-523.
Almost all ophthalmologists have had their highs and lows during their cataract surgery training. To become a safe and technically proficient cataract surgeon is a challenge and to pass on these skills to residents and fellows is as challenging if not more.
Pediatric cataract surgery training has its own unique set of challenges in addition to those a mentor and mentee would face while teaching/learning cataract surgery in adults. Over time surgical skill transfer has been done via the apprenticeship model where an experienced mentor watches a mentee’s surgery and passes on skills to a rubric based system where the mentor scores each step in the surgery being performed . While the former helps the mentee feed off the experience and expertise of the mentor, the latter also adds an element of objectivity while retaining the benefits of the former .
There are a lot of rubrics today that can help with assessing the quality of cataract surgery done. These include International Council of Ophthalmology-Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR), Objective Assessment of Skills in Intraocular Surgery (OASIS), and Global Rating Assessment of Skills in Intraocular Surgery (GRASIS) . Swaminathan and associates have come up with ICO OSCAR for pediatric cataract surgery . If mentees can be given real time feedback during surgery with these rubrics or if the mentor is able to watch the video with the mentee and objectively score each step with the aforementioned rubrics, it is a step forward in creating safe and technically sound cataract surgeons.
Video analysis of surgical steps has been used earlier. Pittner and associates have reported the value in surgical skill transfer . Badakere and associates have used video analysis along with the ICO OSCAR for pediatric cataract surgery to compare surgical skills between pediatric ophthalmology faculty and pediatric ophthalmology trainees. They also went a step ahead and studied the challenges faced by pediatric ophthalmology fellows at various points in their training and came up with some interesting relevations. There were certain steps in pediatric cataract surgery that new trainees scored lesser on compared to others [5-7].
The more experienced fellows also took a shorter time to complete surgery. The interesting finding was that fellows experienced in small incision cataract surgery and phacoemulsification in adults had a shorter learning curve. So what then is the way forward in pediatric cataract surgical training? Sufficient exposure to cataract surgery in adults prior to operating in children has its benefits. However, if this is not a part of the training curriculum, wet lab exposure and training on a surgical simulator prior to operating on patients would also help. These steps along with video analysis and rubrics would make surgical skill transfer very robust.
- Rogers GM, Oetting TA, Lee AG, et al. Impact of a structured surgical curriculum on ophthalmic resident cataract surgery complication rates. J cataract refract surg. 2009; 35:1956-60.
- Swaminathan M, Ramasubramanian S, Pilling R, et al. ICO-OSCAR for pediatric cataract surgical skill assessment. J AAPOS. 2016; 20:364-5.
- Puri S, Sikder S. Cataract surgical skill assessment tools. J cataract refract surg. 2014; 40:657-65.
- Pittner A, Nolan M, Traish A, et al. Standardized approach to training for cataract surgery skill evaluation. J cataract refract surg. 2016; 42:855-63.
- Badakere A, Chhablani PP, Chandrasekharan A, et al. Comparison of Pediatric Cataract Surgical Techniques Between Pediatric Ophthalmology Consultants and Fellows in Training: A Video-Based Analysis. J Pediatr Ophthalmol Strabismus. 2019; 56:83-7.
- Badakere A, Sachdeva V, Sheth J, et al. ICO-OSCAR scoring for pediatric cataract surgeries performed by pediatric ophthalmology fellows in training—stage of fellowship and quality of surgery. J AAPOS. 2021; 25:99-e1.
- Ramani S, Pradeep TG, Sundaresh DD. Effect of wet-laboratory training on resident performed manual small-incision cataract surgery. Indian J Ophthalmol. 2018; 66:793-7.