Many NBA players, including Kobe Bryant, work with personal shooting coaches. Despite already having achieved a great level of success, players look to these coaches to help them improve their shooting skills through a variety of drills and teaching methods.

The same goes for Major League Baseball players, all of whom have worked with a personal hitting or pitching coach at some point in their lives — and still do as professional players.

There are many reasons why we can apply the same principle to cataract surgery. Having a personal coach could accelerate the learning curve beyond what happens in residency, creating more skilled surgeons at an accelerated rate.

Here, I explain why now is the time for cataract surgery coaches, what young surgeons can learn from them and what the ideal coaching relationship could look like.

DIRECT FEEDBACK ON TECHNIQUE

As an ophthalmologist who practiced for 41 years, I have had the privilege of a rewarding career that started with intracapsular cataract surgery. I was in practice when I had to learn extracapsular cataract surgery followed by phaco, and I continued to refine my technique to modern cataract surgery.

For many years, residencies required the residents to begin with their first cataract case with extracapsular cataract extraction (ECCE), but those days are over. Today, residents learn phacoemulsification from the get-go, and many do not know how to convert to ECCE.

In fact, even back in 2017 only one program required residents to perform ECCE before performing phacoemulsification.¹ Clear corneal phacoemulsification was the first technique taught to trainees at 91% of programs.¹

Some lucky residents get through residency without breaking the bag, but that also means that they have never been in the hot seat for an anterior vitrectomy. This can make their first few vitrectomies very stressful.

I started with intracapsular cataract extraction, which increased my sewing skills. But many surgeons have limited experience suturing after a general ophthalmology residency. If this sounds like you, I encourage you to practice this in a wet lab and then have a low tolerance for sutures until you feel proficient.

But what if we looked at that idea of skill building on a larger scale? Wet labs and YouTube videos certainly have value, but it may not be enough. Nothing replicates learning during actual cases. Of course, the risk of making a major mistake from inexperience can weigh heavily. Therein lies the catch-22 — how to improve on the finer skills without putting the patient at risk.

That is where a personal cataract coach comes into play. A more experienced surgeon could spend some time watching live cases, offering helpful hints or suggestions, serving as a guide when things go sideways (like that unexpected vitrectomy) and providing a playbook for areas of improvement and encouragement around skills that are already solidly refined (See “My vision: The cataract coaching relationship”).

NOW IS THE TIME TO EXPLORE COACHING

Cataract coaches would be especially beneficial during a period when time is not on the side of the ophthalmology community.

The need for cataract surgery is rising significantly and could reach critical mass in the coming years. If surgeries continue to grow at the rate they have during the last 15-20 years, they will require a 128% growth in volume by 2036.²

What complicates matters even more is the age of the current crop of physicians handling a large portion of patient care. A 2019 report from the American Association of Medical Colleges (AAMC) found that 27% of the current physician workforce is between the ages of 55 to 64. Another 15% of doctors are over 65, meaning that 42% of all physicians are at least 55 years old. The report estimates that more than 40% of physicians could retire in the next decade.

Assuming those numbers translate closely to ophthalmology and the AAMC does estimate a shortage of ophthalmology providers by 2025, that means that more cataract surgeries will have to be performed by fewer surgeons. Soon, those numbers will become too much to manage without some help from within. The current crop must become more efficient and more productive. That could mean more surgery days or simply more cases per surgery day. A cataract coach could be one mechanism to make that happen.

A more skilled surgeon is a more confident surgeon. More confident surgeons can work faster and are willing to take on more responsibility. They aren’t afraid of what they could see next faced with more cases. That all adds up to more volume.

Kobe Bryant was fearless. He was willing to take any shot at any time. Sure, some of that confidence came from some part of his personality — the “Mamba mentality” as he liked to call it. But a huge part of it came from the hours he put in with a coach, sharpening his craft, planning for every possible scenario when game time arrived.

Having an experienced surgeon on hand once a month or a few times a year, for instance, who has already seen it all could be invaluable to a young surgeon who simply needs an open mind, a willingness to learn and, most importantly, more self-assuredness to move to a greater level of productivity.

VALUE OF HIGH VOLUME ALREADY DEMONSTRATED

Despite the bleakness of some of the above data, there is some good news, and it ties into what creating more prolific surgeons can do.

On an annual basis, the incidence of capsule complications decreases with an increased number of procedures.³ High-volume surgeons are increasingly doing more cases, but their number of issues are decreasing. Practice doesn’t necessarily make perfect, but it makes things abundantly better.

While these numbers may not illustrate absolute perfection, they are getting closer. More importantly, they magnify that having more productive surgeons will help handle the wave of procedures that will be necessary in the coming years AND give patients better outcomes. That’s a win-win.

High-volume surgeons are taking on even more of the case burden. Many of those are the surgeons, like me, who came out of residency with a wider range skill set. We need more of those whether that full training is coming in residency or not.

CONCLUSION

The goal within the concept of a cataract coach is to create those surgeons earlier in their years of practice. But it doesn’t have to be limited to just younger surgeons. Those that have been at the craft for a while could also benefit from sharpening the surgical saw. It could just be the nudge that gets them to that next level. As all signs point, the profession needs this to meet the growing demands of an aging population.

Kobe didn’t become a five-time champion and Hall of Famer all on his own. He needed coaching. Perhaps more of us do too. OM

REFERENCES

1. Lotfipour M, Rolius R, Lehman EB, Pantanelli SM, Scott IU. Trends in cataract surgery training curricula. J Cataract Refract Surg. 2017;43(1):49-53.
2. Hatch WV, Campbell Ede L, Bell CM, El-Defrawy SR, Campbell RJ. Projecting the growth of cataract surgery during the next 25 years. Arch Ophthalmol. 2012;130(11):1479-1481.
3. Zetterberg M, Montan P, Kugelberg M, Nilsson I, Lundström M, Behndig A. Cataract Surgery Volumes and Complications per Surgeon and Clinical Unit: Data from the Swedish National Cataract Register 2007 to 2016. Ophthalmology. 2020;127(3):305-314.

Pamela Williams, MD, spent 41 years in the practice of general ophthalmology in Phoenix. She was in private practice then worked at Cigna Medical Group the last 26 years. She retired in 2020 and now runs an eye clinic at the Phoenix Dream Center providing free exams and glasses for anyone in need. Email her at Dr_pamela1950@yahoo.com.