Resident Heart Rate Variability During Cataract Surgery

Purpose: To evaluate ophthalmology resident anxiousness and cardiovascular response by tracking resident heart rate (HR) when performing cataract surgery during their last year of residency. Methods: A prospective analysis of 31 cataract cases, completed by three residents (two females and one male), at the Kresge Eye Institute in August and September 2020 was performed. Inclusion criteria for cases included all cataract cases performed by PGY-4 residents at the Kresge Eye Institute who downloaded the Heart Graph app supported by iOS. Residents with android mobile devices were excluded from the study. Informed consent was obtained from all residents who utilized the MOOFIT tracker and no incentives or penalties were utilized by the department during this study. Results: Residents were divided by gender. Total HR mean(SD) was significantly elevated for female residents with a HR of 107.4(13.0) for females and 81.4(11.5) for males (P0.05). Conclusion: Our study shows a significant difference in peak and sustained HR response between female and male ophthalmology residents while performing cataract surgery. The cumulative effect of high HR on the overall health of residents, training in the surgical specialty of ophthalmology, needs further investigation

Complication Rates in Resident Cataract Surgery After Elective Operating Room Shutdown During the COVID-19 Pandemic

Purpose: To assess the types of cataract surgeries being performed at one large eye institute from before and after the COVID-19 induced shutdown of elective surgeries in Spring 2020. Methods: This is a retrospective chart review study of operative reports from resident performed cataract surgeries from January 1st, 2020 through July 31st, 2020. Cataract surgeries were categorized into Pre-COVID (Jan – Mar 2020) if they occurred prior to operating room (OR) shutdown on March 18th, 2020 and Post COVID for all cases which occurred after the shutdown orders were lifted (May – July 2020). A resident survey was also used to gather data regarding resident case numbers and resident concern performing cataract upon re-opening of the operating room for elective surgeries. Results: A total of 480 cases (n=306 Pre-COVID and n=174 Post-COVID) were analyzed. Our study shows a higher frequency of complex cataract surgeries being boarded after the COVID-19 pandemic induced shutdown of elective surgeries in Michigan (P\u3c0.0001). However, the incidence rate of complications in resident performed cataract surgeries was not significantly higher immediately following the government induced shutdown. Complications analyzed included anterior rent or capsulorrhexis, wound burn, placement of iris dilator, posterior capsular rupture, anterior vitrectomy, and capsular ring tension. Survey results showed that phacoemulsification was the step of cataract surgery which residents were most concerned about when returning to the OR after their hiatus from operating. Conclusion: Significantly more complex cataract surgeries were performed immediately after opening of the OR, however, there was no significant increase in resident complications in performing cataract surgery

Post-operative Day 1 versus Day 0 follow-up for Uncomplicated Cataract Surgeries: A comparison of post-operative outcomes and managements

Purpose: To compare the postoperative outcomes and management of uncomplicated cataract surgery (CEIOL) patients seen on post-operative day zero (POD 0) versus post-operative day one (POD 1). Methods: A retrospective chart review of 533 patients who had CEIOL at the Kresge Eye Institute from December 2017 to September 2019 was performed. Visual acuity (VA) and intraocular pressure (IOP) were collected from the pre-operative visit, and the first and second post-operative day visits. In addition, changes in management were recorded from the first post-operative day visit. Patients were excluded if they had a complex cataract procedure, had combined glaucoma filtering surgery, or did not complete two follow up visits within 14 days of surgery. Results: The pre-operative demographic data between patients seen on POD 0 (n=119) versus POD1 (N=414) were equally distributed. By unpaired t-test, the average VA of patients seen on POD 1 was significantly better than those seen on POD 0 (P0.50). Conclusion: There was no significant difference in management between POD 0 and POD 1 patients having undergone uncomplicated cataract surgeries. Therefore, surgeons can safely consider POD 0 or POD 1 evaluations for uncomplicated cataract surgeries and improve healthcare cost efficiency for CEIOL

Factors Associated With 5-Year Glaucomatous Progression In Glaucoma Suspect Eyes: A Retrospective Longitudinal Study

Purpose: To study the association of 5-year glaucomatous progression with several demographic, clinical, visual field and optical coherence tomography (OCT) variables in glaucoma suspect eyes. Methods: A retrospective chart review of 365 eyes of 288 patients were included (323 eyes with suspicious cup-to-disc ratio and 42 eyes with ocular hypertension). The study subjects were divided into two groups: eyes that progressed to glaucoma and those that did not. We calculated the percentage of glaucoma suspect eyes that progressed to glaucoma within 5 years. The inclusion criteria were glaucoma suspect eyes (i.e., suspicious cup-to-disc ratio and/or intraocular pressure \u3e21 mm Hg), age ≥ 30 years old, follow-up time of 5 years, best-corrected visual acuity 20/100 or better, spherical equivalent better than −8 diopters and astigmatism less than 3 diopters. We excluded eyes with any significant retinal or neurological disease, and glaucoma which was determined by at least 2 consecutive reliable visual field tests regardless of the appearance of the optic disc. Results: Bivariate analysis showed eyes that progressed to glaucoma had significantly worse mean deviation, higher pattern standard deviation (PSD), less visual field index, thinner average, superior, and inferior retinal nerve fiber layer thickness (RNFL), and more severe average, superior, and inferior RNFL damages (i.e., color grading scale) at baseline. Logistic regression analysis showed only PSD and severe inferior RNFL damage (i.e., red color) were significantly associated with 5-year glaucomatous progression. Conclusions: Segmental RNFL damage and PSD are associated with 5-year glaucomatous progression in glaucoma suspect eyes

Professional Coaching in Residency: A Novel Approach to Decrease Resident Burnout

Purpose: To implement and analyze an organizational level coaching program for ophthalmology residents at the Kresge Eye Institute (KEI) as the front-line method for prevention and management of physician burnout. Background: Burnout is a well-documented stressor in medicine and has been shown to significantly increase unprofessional conduct and medical errors. A recent, promising model to tackle burnout in the medical field is coaching. The Harvard Business Review and American Medical Association have demonstrated the positive effects of coaching on professional performance and well-being. Methods: We plan on utilizing the Kern Method to develop a resident wellness curriculum addressing resident burnout. This curriculum will focus on implementation of professional coaching and we will evaluate the success of this program though survey data. Surveys will evaluate the programs prior to coaching implementation, and at 6 months and a year of implementation. Results: A total of 21 residents will have access to professional coaching. We will measure the residents’ ability to adapt new vocabulary, knowledge, and tools to tackle burnout, into their education. Data will be gathered through surveys grading the effectiveness of our coaching curriculum in all stages of the Kirkpatrick Pyramid for program evaluation. Conclusion: The stigma of depression and anxiety impacts a physician ability to seek help regarding burnout. We expect that our program will have increased participation as coaching is a professional benefit unaffected by a mental health stigma. We hope this program serves as a broadly applicable model for improving resident wellness across specialties throughout the country

Intraoperative Complication Rates in Cataract Surgery After Resuming Surgery Following the COVID-19 Shutdown

PURPOSE: To evaluate surgeon performance and intraoperative complication rates of cataract surgery after resumption of elective surgeries following the operating room (OR) shutdown from the coronavirus disease 2019 (COVID-19) pandemic. Subjective surgical experience is also evaluated. METHODS: This is a retrospective comparative study which analyzes cataract surgeries performed at an inner city, tertiary academic center. Cataract surgeries were categorized into Pre-Shutdown (January 1-March 18, 2020), and Post-Shutdown, for all cases which occurred after surgeries resumed (May 11-July 31, 2020). No cases were performed between March 19 and May 10, 2020. Patients undergoing combined cataract and minimally invasive glaucoma surgery (MIGS) were included, but MIGS complications were not counted as cataract complications. No other combined cataract-other ophthalmic surgeries were included. A survey was used to gather subjective surgeon experience. RESULTS: A total of 480 cases (n=306 Pre-Shutdown and n=174 Post-Shutdown) were analyzed. Although there was a higher frequency of complex cataract surgeries performed Post-Shutdown (5.2% vs 21.3%; p CONCLUSION: After the surgical hiatus due to COVID-19, significantly more complex cataract surgeries were reported and surgeons reported higher general anxiety level when first returning to the OR. Increased anxiety did not lead to higher surgical complications. This study provides a framework to understand surgical expectations and outcomes for patients whose surgeons faced a prolonged two-month hiatus from cataract surgery