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Lee Jones, Vinette Cross, David P Crabb, Peter Shah; High-stakes ocular surgery through the eyes of the surgeon: Experiences of operating on ‘only-eye’ patients.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):465. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Operating on patients with only one seeing-eye is high-stakes surgery with the potential for catastrophic loss of vision. This study investigates the behaviours, opinions, and experiences of surgeons caring for ‘only-eye’ patients undergoing ocular surgery. The aim was to explore surgeons’ perceptions of the current practice for only-eye surgery, and also to learn how surgeons attempt to optimise safety in these procedures.
Using purposive sampling, eight surgeons (Female = 2) with experience of conducting ophthalmic surgery (6 to 28 years) were invited to take part in a 40-minute semi-structured interview about performing only-eye surgery. Interviews were conducted by a health psychologist and a senior ophthalmic surgeon, and qualitative analysis of the transcripts was carried out using a thematic analysis approach.
The interviews yielded several recurring themes pertinent to the study aims. For optimising patient safety, tailored pre- and postoperative care, including rigour during the consent process and choice of anaesthetic to administer, were frequently cited as important aspects to consider in only-eye surgery. Successful outcomes in only-eye surgery were attributed to such factors as: logistics, including staffing and scheduling; mentorship, including encouragement and sufficient training; and the adoption of specific coping mechanisms, including motor imagery (for example, task visualisation), optimism, and faith. Concerns over current practice in only-eye surgery related to a perceived lack of formal support in the event of devastating surgical outcomes, and an absence of available time to utilise such services. For example, there was a consensus that the second victim phenomenon is not well-recognised in the field of ophthalmic surgery.
This multinational study highlights the advice and concerns of ophthalmic surgeons performing only-eye surgery. Our results help to explain how surgeons gain resilience and are able to manage the complexities that are inherent with only-eye surgery. The findings of this study offer important insight into only-eye surgery which has not previously been explored. Moreover, our results have potential to serve as an essential resource for learning and professional development in ophthalmic surgery, and describe the challenges to overcome to help improve service delivery.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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