September 16, 2025
2 min read
Key takeaways:
- The night before surgery, trainees should rehearse procedure steps and review potential complications.
- Every surgery should be recorded for a postoperative debriefing.
COPENHAGEN, Denmark — Surgeons who are preparing for their first cataract surgery require mental and physical readiness, according to a speaker at the European Society of Cataract and Refractive Surgeons meeting.
Paul Rosen, BSc, MB ChB, FRCS, FRCOphth, MBA, of Oxford Eye Hospital, said training for cataract surgery begins in wet labs and dry labs. Practicing in these settings provides familiarity with the procedure, the instruments and the microscope.
Image: Alex Young | Healio
Surgical simulators play an important role in increasing skills and situational awareness while also providing an objective assessment of performance, Rosen said.
“It is sort of a self-assessment as to how you are doing in your surgical techniques,” he said. “Even if you’ve done 10, 20 or 30 cataracts, it’s still worthwhile to go back and use the simulators and keep practicing, particularly if there’s a period between your last case and the next one.”
Once surgeons are ready for their first surgery, they need to focus on selecting the right case, Rosen said. First-time cataract surgeons should review patient records several days in advance and choose a case with no expected complications. Ideally, a trainee should operate on the second eye so the patient is calm.
“You want a calm patient, which I think leads to a calm surgeon,” he said. “There’s also informed consent that they are in a training institution, and there’s no guarantee that the operation will be done by the senior surgeon. We’re all working together.”
Rosen said it is good to rehearse the procedure steps the night before surgery and review potential complications and alternative ways to complete the procedure.
The day of the procedure should begin with a preoperative briefing with a supervisor so surgeons can talk through the procedure and decide who is doing what. In some settings, trainees begin with inserting the IOL in their first procedure and then work backward through each step with each successive surgery until they can start at the beginning of a case.
Trainees and supervisors should use this briefing to agree on a signal if there is a complication during the surgery to switch to the senior surgeon.
“Remember, these patients may well be more likely to be under local anesthetic only,” Rosen said. “They can hear what you’re saying. If there’s a complication and there’s a lot of argument and shouting, the patients remember. When they leave the operating room, they go and talk to their lawyer. So, have rehearsed signals that are calm and don’t cause distress for the patient.”
Finally, Rosen said recording every surgery is critical to the learning process. Reviewing these recordings afterward allows trainees to debrief with supervisors to determine what went well, what did not and what they can do differently.
“You’ll never feel completely ready,” Rosen said. “At some point you’ve got to start and then trust in your supervisor and in your own skills that you’ve learned in the wet labs and in the simulators.”
Sources/Disclosures
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Rosen P. Preparing for my first (cataract) operation. Presented at: European Society of Cataract and Refractive Surgeons meeting; Sept. 12-16, 2025; Copenhagen, Denmark.
Disclosures:
Rosen reports consulting for Ufonia and VisusNano.
