The European Way of Teaching Ophthalmic Surgery

Abstract

'An ophthalmic surgeon must have certain physical and psychic qualities; he must have excellent vision, a very steady hand, a lot of patience, a passion for the minute and extraordinary precision in following all general and special regulations. In general surgery, inaccurate sterilization, incomplete anaesthesia or even minimal defects in instrumentation or lighting are considered simple difficulties, problems which are easily solved ... in ophthalmic surgery, they can mean the failure of the functional aim of the operation and sometimes eye loss'. This is how, in 1948, B. Leonardi gave the general introduction to his subject 'Chirurgia dell'Apparato Oculare' (Surgery of the Ocular Apparatus) [1], which has since become a kind of bible for Italian ophthalmic surgeons. Almost half a century later, it can be seen from debates and editorials of consultation sections [2] that ophthalmic microsurgery is still considered an art form [2], or a profession where capable dexterity is an unavoidable condition for good results. The basic principle is to minimize trauma. As a result, control, dexterity and precision, normal requisites for general surgery, become keywords. Superficiality, clumsiness, imprecision and inattention should be avoided at all costs. An operation of ophthalmic microsurgery must be perfect and work, otherwise problems or complications will arise sooner or later; half measures, possible compromise, the 'good enough' have very narrow margins. Quoting Leonardi once again ' ... the good ophthalmic operator must possess special skills, some of which are inborn and some which are acquired, that is to say they can result from effort, study and practice. A typical inherited gift is, for example, perfect vision ... another one is a steady hand; ... even a very slight degree of tremor can seriously jeopardize the capacity of the oculist. Naturally what I refer to is a constant tremor, not the unintentional one which can affect the novice during his first operations or which strikes some surgeons who have to operate in the presence of colleagues or away from home. Another inherited gift is a psychic one and is the natural inclination towards minute detail and