Performing manual small incision cataract surgery (SICS) in a rural cataract camp can be daunting for phaco-trained ophthalmologists who are used to operating in modern operating theatres.
See a slide show of Dr. Peterson and her colleagues performing small-incision cataract surgery in India and Nepal.
Learning how to perform this surgery safely and effectively and being familiar with the equipment used to set up cataract camps is important to know before beginning the journey.
I completed my ophthalmology residency at the Singapore National Eye Centre (SNEC), which has a five-year program. I was fortunate to have performed over 600 independent phacoemulsification cataract surgeries before starting to learn SICS at the end of my fourth year of residency.
My colleague, Dr. Joshua Lim, and I obtained financial support from our institution to train on the HelpMeSee SICS simulator in Mumbai, India, before heading to Trilochan Netralaya in Odisha, India, to operate under the supervision of Dr. Shiva Prasad Sahoo.
The HelpMeSee device is a state-of-the-art simulator that utilizes magnetic fields to mimic the feel and resistance of the eyeball. It was very effective in helping us learn our tunnel creation and making a large needle capsulorhexis, both of which are key steps of surgery.
Coupled with our prior surgical experience and the simulator experience, we were able to hit the ground running when we went to Trilochan Netralaya, and we were able to perform our first cases from beginning to end smoothly. That said, we still experienced all the surgical “firsts” again when learning SICS: posterior capsule rupture, iridodialysis, and premature entries. We had to learn how to safely manage them under supervision.
Upon return to Singapore, we made sure to keep up our skill set by first performing SICS together with a senior ophthalmologist who had prior SICS experience in SNEC. Once we were deemed competent, we both continued to post appropriate cases in our own independent surgical lists in SNEC.
More recently, we had the opportunity to join and operate in a cataract camp organized by the Tilganga Institute of Ophthalmology (TIO) in Dhading, Nepal. Our basic microscope, operating table, and instruments were transported on top of the van, which our whole team had to squeeze into, for the four-hour drive through the mountains from Kathmandu to Dhading.
Once we arrived, the local team set up the scrub and steam sterilization room, powered by a gas canister, and transformed a meeting room into an operating room. We had to familiarize ourselves with the flow of patients, operating room, terms our local scrub nurse used for instruments and maneuvering the microscope manually. To avoid waste, the local team would sterilize single-use instruments, such as the crescent blade and keratome, so they could be used for five cases. We had to adapt to using progressively blunter instruments.
Participating in a cataract surgical camp is an eye-opening and rewarding experience. However, transitioning from operating in a “first world” setting to a rural cataract camp can pose some challenges. It is important to receive comprehensive and supervised surgical training when learning SICS, since there are many steps which are different and can be more challenging than phacoemulsification surgery, such as tunnel creation.
Not to mention that complications in a camp setting can be harder to manage with limited equipment, pose a greater infection risk in patients with poor hygiene, and be difficult to access tertiary eye care that is located hours away.
I am fortunate to have received so much support, training, and supervision on my SICS journey. For those planning to start your first SICS journey with the aim of participating in cataract camps, here are some tips:
- Watch as many surgeries as you can (live or on platforms such as YouTube) to familiarize yourself with different surgical techniques and complication management.
- Surgeons can access training on state-of-the-art simulators. As a phaco surgeon, I found learning the SICS tunnel and creating a large needle rhexis on the HelpMeSee simulator especially useful.
- Record your surgeries. Surgeries at both Trilochan Netralaya and SNEC are recorded. This allows us to review our surgeries and receive constructive feedback.
- Practice makes perfect. Try to list appropriate cases on your own lists in your operating theatre at home, in between trips to cataract camps. Case selection is key. I would recommend listing patients with dense cataracts who would be challenging to phaco (e.g., brunescent cataracts with hand motion (HM) or worse vision, but who have deep anterior chambers and good pupil dilation).
- Lastly, stay positive! Performing a new surgery and operating in rural settings can be challenging. Always bring a good team with you and stay motivated!
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About the author: Claire L. Peterson, MBBS, MMed, FRCOphth, is the Young Ophthalmologist chair of the Singapore Society of Ophthalmology. She completed her residency at the Singapore National Eye Centre, where she is pursuing a fellowship in glaucoma. Dr. Peterson joined the Academy’s YO Info Editorial Board in 2024. |
Performing Small Incision Cataract Surgery