Two-Week Phaco Training Roster for Residents
Two-Week Phaco Training Roster for Residents
Years in Eye Care
Surgeries Per Year
Eye Specialists
Patients Per Year
Years in Eye Care
Surgeries Per Year
Eye Specialists
Patients Per Year
Program Philosophy
The program is designed to move residents through three key phases:
- Observation: Residents observe experienced surgeons to understand the flow, nuances, and critical steps of the procedure.
- Assisted Performance: Residents perform initial, low-risk steps of the surgery on actual patients under direct supervision, with the attending surgeon ready to intervene. This is a critical component of hands-on OR experience.
- Supervised Performance: Residents perform the complete surgery on actual patients with the attending surgeon present, providing real-time feedback and guidance.
Key Components
- Daily Schedule: A consistent daily routine for surgical time, didactic sessions, and video review.
- Hands-On OR Experience: The core of the program, where residents progressively gain more responsibility for surgical steps on real patients, from basic incisions to a complete case.
- Video Review: A crucial component where residents and attending surgeons analyze surgical videos to identify areas for improvement and reinforce correct techniques.
- Progressive Difficulty: The complexity of cases the resident performs increases as their skills develop.
Week 1: Foundations and Assisted Performance
Goals:
- Understand the principles of phacoemulsification and machine dynamics.
- Become familiar with the operating room (OR) setup, instruments, and patient positioning.
- Master the initial steps of the surgery, such as incision creation and capsulorhexis, under direct supervision on actual patients.
- Begin to develop a mental map of the surgical flow.
Monday: The Phacoemulsification Primer
Morning (OR):
- Observation (4–5 cases): Resident observes the attending surgeon performing phacoemulsification. The attending surgeon provides commentary explaining each step, instrument use, and machine settings.
Afternoon (Didactic & Hands-On OR Experience):
- Didactic Session: Introduction to the phaco machine, fluidics, and basic surgical steps (incisions, capsulorhexis, hydrodissection).
- Hands-On OR Experience (1–2 cases): Resident performs basic steps such as speculum placement, marking the eye, and setting up the surgical field.
End of Day (Video Review):
- Review videos of the surgeries observed in the morning. The attending highlights key steps, pitfalls, and techniques.
Tuesday: First Steps Under Supervision
Morning (OR):
- Observation (2–3 cases).
- Hands-On OR Experience (2–3 cases): Resident performs incision and paracentesis under direct supervision. Attending completes the remainder of surgery.
Afternoon (Didactic & Hands-On OR Experience):
- Didactic Session: Focus on continuous curvilinear capsulorhexis (CCC) and hydrodissection.
- Hands-On OR Experience (1–2 cases): Resident attempts first CCC under close supervision.
End of Day (Video Review):
- Review videos of assisted performance cases, focusing on incision and CCC.
Wednesday: Nucleus Dissection – Part 1
Morning (OR):
- Resident performs incision, capsulorhexis, and hydrodissection.
- Resident guided through sculpting/trenching under supervision. Attending completes nucleus removal.
Afternoon (Didactic & Hands-On OR Experience):
- Didactic: Detailed discussion of phaco energy, sculpting, trenching techniques.
- Hands-On OR Experience (1–2 cases): Resident practices sculpting under supervision.
End of Day (Video Review):
- Review resident’s trenching technique, microscope focus, and hand-eye coordination.
Thursday: Nucleus Dissection – Part 2
Morning (OR):
- Resident performs all steps up to cracking the nucleus. Attending assists with cracking and completes the case.
Afternoon (Didactic & Hands-On OR Experience):
- Didactic: Discussion of chopping techniques and handling posterior capsular tears.
- Hands-On OR Experience (1–2 cases): Resident practices cracking techniques.
End of Day (Video Review):
- Review resident’s trenching precision and cracking force.
Friday: Cortex Removal and IOL Insertion
Morning (OR):
- Resident performs all steps up to nucleus removal. Attending completes removal and guides resident through I/A of cortex and IOL insertion.
Afternoon (Didactic & Hands-On OR Experience):
- Didactic: Detailed review of cortical cleanup and IOL insertion methods.
- Hands-On OR Experience (1–2 cases): Resident practices I/A and IOL insertion.
End of Day (Video Review):
Review resident’s I/A and IOL insertion, emphasizing meticulous cortex removal and proper IOL orientation.
Week 2: Supervised Performance and Independent Completion
Goals:
- Combine all surgical steps into a seamless, complete procedure.
- Increase efficiency and confidence.
- Begin to manage more complex cases (e.g., smaller pupils, denser cataracts).
- Perform the entire phacoemulsification procedure under direct supervision.
Monday: First Full Surgery
Morning (OR):
- Resident performs full surgery (2–3 cases) under close supervision. Attending provides real-time guidance.
Afternoon (Didactic & Hands-On OR Experience):
- Didactic Session: Managing different complexities (shallow AC, small pupils, PXF).
- Hands-On OR Experience (1–2 cases): Resident performs another full surgery focusing on flow and efficiency.
End of Day (Video Review):
- Review resident’s first complete surgery step-by-step with detailed feedback.
Tuesday – Friday: Progressive Autonomy
- Resident performs 4-6 supervised cases daily. Attending reduces input gradually, resident handles more decision-making.
- Tuesday: Post-op care and management of complications.
- Wednesday: IOL power calculation and lens options.
- Thursday: Handling intraoperative complications (capsular tear, dropped nucleus).
- Friday: Wrap-up session on surgical development and best practices. End of Day (Video Review):
- Daily review focusing on surgical decision-making, efficiency, and complication handling.
Friday (End of Week 2): Program Conclusion
Final Review:
- Attending provides summative evaluation, highlighting strengths and growth areas.
Certification:
- Resident receives case logbook and certificate of completion.
Frequently Asked Questions
Individuals with diabetes, particularly those with poorly controlled blood sugar, are at risk. The risk increases with the duration of diabetes.
Treatment options include laser therapy, anti-VEGF injections, and surgery, depending on the stage of diabetic retinopathy.
Maintaining a healthy lifestyle, including a balanced diet, regular exercise, avoiding smoking, and managing diabetes, can contribute to prevention and overall well-being.
While not always preventable, strict blood sugar control, regular eye exams, and a healthy lifestyle can help prevent or slow its progression.
People with diabetes should have a comprehensive eye exam at least annually. More frequent exams may be recommended if diabetic retinopathy is present.
Medications are not a primary treatment for diabetic retinopathy. Management involves controlling diabetes, regular eye exams, and, if needed, specific treatments like laser therapy or injections.
Joint Commission International, USA (JCI)
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