The academic year recently came to a close, and in the next few weeks about 500 new ophthalmologists will start practice across the United States. For the past 2 decades, these young ophthalmologists have asked me for a few pearls of wisdom as they begin their careers. My advice has been consistent and has focused on 3 areas: evolving your practice, getting up the learning curve, and doing what is best for patients.

Evolving Your Practice

Whether you’re in private practice, in a large multispecialty group, or in full-time academic medicine, it is critical to keep up with changes within your field. Because ophthalmology advances so rapidly, the way that we do things today is not the same as it was years ago. Cataract surgery is now more refractive in nature, glaucoma surgery has moved toward minimally invasive techniques, endothelial transplantation has transformed corneal surgery, and intravitreal injections have become the mainstay for treatment of many retinal diseases. The only constant in ophthalmology seems to be change.

Keeping up with new changes in ocular surgery is critical to providing patients with the best possible outcomes. Surgical techniques evolve and new technologies are introduced every year, with the goal of making surgery safer, less invasive, more predictable, and increasingly efficient. If it is not feasible for your practice or surgery center to purchase costly new technologies, see if you can get privileges at other facilities or rent the equipment yourself. While it is useful to read about the experiences of others, ultimately your best understanding comes from actually using these devices during surgery. You can then decide if something is worth pursuing.

Getting Up the Learning Curve

Every new technology and technique comes with a unique learning curve. While it may take 1000 cataract surgeries to truly feel comfortable with all combinations of potential complications, other procedures can be mastered with far fewer numbers. When femtosecond lasers were first introduced for cataract surgery, the complication rate was higher because surgeons had not yet climbed the learning curve for that device. Now femtosecond-assisted cataract surgery has complication rates similar to those of an expert surgeon without the laser.

To master surgical techniques, be self-critical: watch your surgical video footage and have the drive and determination to make each surgery better than the previous one. For each case, is there a way that you could have done it better, safer, or more efficiently? Think about each step of the surgery and how it could be improved. Whereas a novice will see our corneal phaco incision as simply an entrance into the anterior chamber, a more experienced surgeon will notice the incision architecture, balance and positioning. Entire articles in this series of columns have been written about just the incisions for surgery.

The Golden Rule of Surgery

Among the most difficult aspects of surgery to learn is surgical judgment—when to do which steps to give the best outcomes for patients. Sometimes, novice surgeons will be too eager to operate even when the risks outweigh the benefits. And other overly conservative surgeons will be reluctant to operate even when surgery is likely the best solution to a difficult case. The best surgical judgment is likely somewhere in the middle. At the beginning of our careers, it is helpful to emulate mentors and follow their lead, and then as we mature as surgeons and gain more experience, we can develop our own surgical judgment.

Ultimately one of the most useful guides is the Golden Rule of Surgery, which simply states that we want to deliver the same high level of care that we would want for ourselves. This means when you see a complicated patient with a challenging case, the best course of action becomes clearer when we ask, “What would I want if this were my eye?”

This approach also reminds us that each case is unique and that each patient deserves your best. Surgery is a pleasure and it is the highlight of my practice. There is simply no greater satisfaction that giving patients the gift of sight.

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