Years of training on the road to success

Cynthia Bradford MD has some pearls of wisdom for young surgeons

Aidan Hanratty

Posted: Tuesday, July 10, 2018

 Dr Alison Blake (left), President of the Irish College of Ophthalmologists, pictured with Dr Cynthia Bradford at the Irish College of Ophthalmologists Annual Conference 2018

Are cataract surgeons victims of their own success? That was the question asked by Cynthia Bradford MD in her Mooney Lecture at the Irish College of Ophthalmologists Annual Conference 2018, held in Kilkenny, Ireland. Dr Bradford, immediate past president of the American Academy of Ophthalmology, made the analogy that cataract surgeons were not unlike downhill skiers.
“It takes years of training. You must be in shape. You have to be mentally alert. You have to be prepared for the course, you have to know where you’re going, you have to maintain your balance and have just the right amount of tension and energy, you have to overcome your fear and you have to have fun.”
While no one thinks that 140kmph downhill runs are easy, the public perception of cataract surgery is that it is easy. The opposite is the case. “We have many fast runs down the hill in a single surgical day,” Dr Bradford said, “and everybody expects us to have a win on every one of those surgeries.”
The work begins long before surgery, however. Dr Bradford engages her patients in conversation, remarking on their outfit or asking them their pastimes. The former is an icebreaker; the latter could become key to learning what kind of vision the patient needs. “Are they a golfer or are they a reader?” This personal engagement helps the patient feel relaxed, and then allows the surgeon to tally the patient’s own description with their records and scans.
Talking to patients about the pitfalls of surgery is important. A long eye may require a special order implant lens, which could limit options. Or a fellow eye with a previously inserted PMMA lens may have different optical qualities than newer implant lenses. A consultation can become a negotiation. “You have to repeat, probe and clarify,” Dr Bradford said. “We’re trying to figure what they want, what they need, and what we can do for them, and bring those three together, because what they want may not be what they need.”
Patients may not even need surgery. “You have to honestly evaluate the patient and decide will cataract surgery improve what they need and will it improve their vision.” Glasses or drops may help instead – no one regrets not having surgery, she said.
Knowing a patient’s history helps too. A patient may have a fear of the operating room because a family member lost their sight following surgery. One patient of Dr Bradford’s was a war veteran who warned that he may “come up swinging” after anaesthetic. Cataract surgery may be a common surgery, but it’s important to remember that this is a first for the patient. This is why Dr Bradford makes such an effort to speak to patients on a personal level.
“Sometimes they’re a little intimidated with us,” she told EuroTimes. “But if you break the ice with them then all of a sudden, they open up, they’re like ‘this is a real person I can talk to’.”
Preparation can then begin weeks in advance. Dr Bradford advises diabetic patients to watch their blood sugar levels at least a fortnight ahead of surgery. “Patients don’t like to be cancelled, because it disappoints them, it disappoints us.”

Patients may be nervous about their operation, so Dr Bradford encourages her students to use friendly, calming words. Rather than asking if the patient feels claustrophobic when the drape is put over their face, she likes to say “I’m going to gently tuck you in”. Don’t ask patients if they’re nervous, she recommends, but ask if they’re comfortable. When they ask after the surgery if they did okay, tell them they did great.
The surgeon should enjoy themselves too. “Surgery is almost like a game. You’ve just got to keep up with it, like playing soccer. You’re watching for everything, trying to make every move as good as you can and allow the next step to be successful and you just start having fun doing it,” she told EuroTimes.
Ultimately, she counts herself lucky to have chosen the field of ophthalmology. “It gives us the pleasure of giving patients quality of life, with the patient perception of ‘it was absolutely nothing’.”
Cynthia Bradford: