Whenever I see Rafa Nadal power through a seemingly impossible inside-out forehand, the thought of how many hours of practice it took him to be able to pull off that move.  Maybe with heroic training, I, too, can become a superstar eye surgeon.

The reality is that the world only has one Rafa, but about 700 new ophthalmologists finishing their residency training annually in the U.S. alone.  Some will be better surgeons, but all of us will [hopefully] be able to perform safe surgery for our patients.

Fortunately for us, the ability to become an efficient, skillful surgeon doesn’t require  innate superhuman ability, only practice and attention to detail.  Seven months ago when I performed my first phacoemulsification, my cut to close time exceeded that of my large incision extracapsular cases.  Now I can probably perform 5 routine cases in the same amount of time.

Interestingly, the total number of cases I’ve performed in 7 months has been limited.  However, I think that there are several principles to follow when learning surgery (other than the need for experience):

• Operative time often correlates with early postoperative result.  In general, the longer you mess with tissue, the more bruising you get. In cataract surgery, this translates to cornea edema.
• The speed of the surgery does not correlate with how quickly you move your hands, but rather how efficient each movement is.
• Read the point above AGAIN. Each movement should have a clear purpose to help move you one step closer to finishing the case successfully.
• Know what to do before you enter the OR. Learn the steps of the case, and have an idea what to do when basic complications arise.
• Learn from your peers. Watch their videos and figure out how they get out of trouble.

Lastly, go in with confidence! We all have good and bad days. The good surgical days will come if you believe in it!

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Snooki is an idiot. I was recently made aware of her quote in Ok! magazine that false eyelashes are functional even during sleep.  This statement is absurd for many reasons, but false eyelash use during sleep certainly raises concern about one’s hygiene.  It does not require much knowledge of science to realize that these eyelashes must attach to the eyelid somehow using an adhesive.  Common eyelash glues consist of latex, gum, and a touch of formaldehyde as a fixative.   Given this composition, I’d imagine that I would not want this material on my skin or near my eyes longer than necessary.  Many companies market these glues as certified as waterproof–to me this just means that more dirt will be able to stick to them from the longer duration of use.

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I’m often asked by my non-ophthalmology friends, “I am near sighted, and I also have astigmatism. My eye doctor tells me that my eye is shaped like a football instead of a basketball. I sort of get it, but what does that mean? Am I deformed?”

Indeed, this explanation captures the essence of the problem, but for most people, having astigmatism does not mean that you have been cursed with a football-shaped eye.  For those my Chinese readers, astigmatism is written as, “散光”. (Mandarin: sǎn guāng; Cantonese: saan2 gwong1)

Again, for MOST people, astigmatism is a condition OFTEN completely correctable with contact lenses, glasses, or refractive surgery, assuming that there are not other underlying issues in your eyes.

In order for the eye to transmit a clear image of what is in front of us to our brain, light travelling into our eye must be focused directly onto the retina.  There are many conditions that can prevent light from reaching the retina, and astigmatism is one of them.  For most issues, astigmatism involves the cornea, a clear structure in the front of the eye that is responsible for bending light entering the eye onto the retina.  For those of use that are near-sighted (myopic), light is focused in front of the retina. For far-sighted folks (hyperopic), light is focused behind the retina (optically speaking). When we visualize this system in the two or three dimensional planes, light at different axes can be bent at different angles, resulting in a variable focus onto the retina. This is astigmatism.

One can have myopia or hyperopia with astigmatism. These two categories are not mutually exclusive.  Your ophthalmologist can accurately diagnose astigmatism and offer treatment recommendations.

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While my GME contract has clear delineations of my job responsibilities as a resident, it is amazing how much additional work we do to survive in the workplace. Back when I was working for the government, nobody breached their job descriptions–there was even a person designated to brew the morning coffee.

In keeping with a concise entry, the following is a list of some tasks I accomplished today. You can decide which ones are reasonable or outright ludicrous:

• Emptied my garbage can into the dumpster: a patient threw a banana peel and apple core in it at 9am–I did not want my exam room to smell like banana the entire day
• Checked my patient’s vision, dilated, them, and filled out a driver’s license renewal form.
• Refused to fill out a disability application for a free Metrocard on an otherwise healthy 33 year-old guy who supposedly had a back injury before he moved to this country. He also had 20/15 acuity.
• Called a primary care physician’s office for records.
• Faxed physical exam requisitions to physician’s office.
• Cleaned the computer keyboard with alcohol swabs.
• Faxed forms to schedule my surgical cases.
• Asked surgical scheduler why he did not fax my surgical cases.
• Spent 2 hrs entering clinic notes on our broken EHR.
• Glared at technician who bypassed my exam lane 3 times while attempting to “find” me to place a patient chart. I was the only physician examining patients in the entire hallway of lanes.
• Called patient to remind her for surgery for tomorrow.
• Performed forced ductions on a STAT 9pm consult in the operating room for someone s/p orbital floor fracture repair. ENT had already closed up the incisions.

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I came across the nastiest, gnarliest, most-awesome scalpel this week, when my attending called for the “Number 12 blade”. In surgery, I’ve only dealt with No. 10, 11, and 15 blades.  I think the picture says it all:

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