vision requirements for eye surgery

[phil_kent2000]

hello everyone,

i'm a long time lurker of this forum, and i've finally worked up the courage to post.

i'm 25 and just started my first year of ophth. residency. i was diagnosed with primary open angle glaucoma 2 years ago and required placement of a drainage device OD about 7 weeks ago (full historical details available upon request). my best corrected visual acuity (i am quite myopic with a sphere of -15 diopters OU) at near is about 20/100 OD and 20/20 OS. i have several paracentral scotomas OD, with one that cuts directly across fixation. visual field OS is completely normal, and pressures are well controlled. my stereopsis is pretty poor. there is a possibility i may need placement of another implant in the right eye in the near future.

my question: is it a wise decision for me to continue into a microsurgical discipline? i've thought about what my long-term (decades) visual prognosis might be, whether or not i would be able to meet the surgical numbers required to become board certified, if it is ethical for a surgeon with obvious vision problems to operate on someone's eyes, and how i would respond to someone putting me under a microscope and asking, "why were you operating with 20/100 in one eye to begin with?". any input into this question would be appreciated. thanks.

---

Members don't see this ad.

 

[Retinamark]

Very tough decision. I've got a friend who was diagnosed with choroidal melanoma, just after sitting her Ophthalmology entrance exams. She had a large ciliary body lesion which needed enucleation. She had a week off for the surgery & got straight back into the exams! God I admire her for that. She is one brave chick.
Anyway, she applied for a training job & there was a bit of controversy. Some surgeons said yes & some said no she shouldn't get a job, based on her lack of stereopsis. She spoke to some one eyed surgeons in the US who were really encouraging. I think there have been some articles about it - try a pubmed search.
She is half way through her training now & doing well.
It's not exactly the same as your situation I know. She has no stereopsis at all obviously, but she has 20/15 vision in her other eye.
I don't think you could do retinal surgery, but you could do neuro-ophth, pediatrics, plastics. If your vision got worse you could find a non-surgical niche. I guess it depends how badly you want it.
Good luck mate

 

[phil_kent2000]

thanks retina for some good advice. your friend certainly is in a quite unfortunate situation and i wish her the best of luck. would you draw a distinction between a surgeon who is monocular with one healthy eye, and one that is monocular with one glaucomatous eye? are there any ethical/patient preference/care issues to consider in operating when it's known that your vision may cause problems (obviously the only way to know for sure is to actually have a problem)? is it simply smarter to learn a new skill while i'm young (25), rather than wait until i'm 35 or 40? just some more questions i'd like perspective on. thanks again.

 

[mdkurt]

My dad (an ophthalmologist) self-diagnosed his normal tension glaucoma about 9 years ago, and is now functionally monocular. He kept operating for a few years after his diagnosis and certainly felt competent, but like you felt that he couldn't defend himself in the event of a complication. I think that most lawsuits in ophthalmology come not from poor technique but rather from poor decision making. Provided your training program is willing to teach you surgery (and that you're seriously motivated to do ophthalmic surgery) you should be able to use monocular cues to operate effectively.

 

[phil_kent2000]

thanks mdkurt for the information. so i take it that your father had ultimately stopped operating? did he by any chance have disability insurance prior to becoming monocular that partially made up for his lost surgical volume? i'm not sure if i qualify for visual disability insurance, since i have a pre-existing condition. again, thanks for the perspective!