ASRS 2024: External exposures affect retina surgeons’ dexterity

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Reviewed by Marina Roizenblatt, MD, PhD

Marina Roizenblatt, MD, PhD, and colleagues from the Department of Ophthalmology, Retina Section, Federal University of São Paulo, Brazil, found that retina surgeons’ dexterity is affected by various external exposures and surgeon experience is a factor. She discussed her team’s findings at the American Society of Retina Specialists 2024 annual meeting in Stockholm.

Their prospective, self-controlled, randomized cohort study included 15 novice and 11 senior retina surgeons, defined respectively as having less than 2 and more than 10 years of surgical experience. The purpose of the study was to determine if experience affects the surgeons’ dexterity response to pharmacologic and behavioral interventions.

The surgical dexterity was tested on an Eyesi-simulator (Haag-Streit). The surgical tasks were evaluated for 5 days after various exposures that included the following: day 1, placebo, caffeine 2.5 (low dose) and 5.0 mg/kg (high dose); day 2, placebo, propranolol 0.2 (low dose) and 0.6 mg/kg (high dose); day 3, baseline, alcohol breathalyzer readings of 0.06-0.10 (low) and 0.11-0.15% (high); day 4, baseline, push-up sets of 50% (low) and 85% (high) repetitions maximum; and day 5, polysomnography recorded 3-hour sleep deprivation.

The study outcomes were the total score (0-700, worst-best) and individual scores for tremor (0-100, best-worst), surgical time (minutes), ocular pathway (mm), and accidental retina touches.

Results based on experience

Roizenblatt reported that the dexterity of the novice surgeons was affected by all of the exposures but was more affected following intake of high caffeine (-29.53; 95% confidence interval [CI], -57.80 to -1.27, p=0.04) and high alcohol (-51.33, 95% CI, -80.49 to -22.16, p=0.01). High alcohol intake increased their ocular pathway (212.84 mm, 95% CI, 34.03 to 391.65 mm, p=0.02) and tremor (7.72, 95% CI, 0.74 to 14.70, p=0.01). Sleep deprivation increased their surgical time (2.57 min, 95% CI, 1.09 to 4.05 min, p=0.01) and tremor (8.62, 95% CI, 0.80 to 16.45, p=0.03). Finally, high-dose propranolol sped them up (1.43 minutes, 95% CI, -2.71 to -0.15 minutes, p=0.03).

Sleep deprivation resulted in more retinal touches by the novice and senior surgeons compared to their baseline values (respectively, 1.22, 95% CI, 0.12-2.43, p=0.02; and 0.73, 95% CI, 0.05 to 1.40, p=0.04).

The novices also had more retina touches after high-dose caffeine intake (1.0, 95% CI, 0.07 to 2.07, p=0.05), and low and high exercise levels (0.57, 95% CI, 0.01 to 1.13, p=0.04; 0.93, 95% CI, 0.19 to 1.67, p=0.01; respectively).

The senior surgeons had more retina touches after high alcohol intake (1.37, 95% CI, 0.31 to 2.41, p=0.01), while a trend was detected for novices (0.72, 95% CI, -0.07 to 1.49, p=0.06).

The total score of the senior surgeons declined after high alcohol intake (-47.36, 95%CI, -80.37 to-14.36, p=0.01).

The researchers concluded, “Alcohol and caffeine impaired novice dexterity; propranolol and sleep deprivation were associated, respectively, with agility and slowness. Alcohol and sleep deprivation increased tremor. Seniors were negatively affected only by alcohol. External factors affected both dexterity scores and retina touches.”

The authors believe that their results can guide surgeons' decisions to enhance their surgical outcomes.

Presentation

Roizenblatt M, Gehlbach P, Jiramongkolchai K, Farah M, Belfort Jr R, Maia M. Experience-based retina surgical dexterity changes after external exposures. Presented at the American Society of Retina Specialists annual meeting, July 17-20, 2024, Stockholm, Sweden. Session: Expert Panel: Surgical