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Editors Selection IGR 15-4

Surgical Treatment: Trabeculectomy training for registrars

Comment by Robert Feldman on:

50566 Trabeculectomy: the limitations for registrar training, Sun LL; Lee GA, Clinical and Experimental Ophthalmology, 2013; 41: 135-139

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Sun and Lee present an interesting look at volumes of trabeculectomy performed by trainees, general ophthalmologists and glaucoma specialists at two public hospitals in Australia. They demonstrate decreasing numbers of cases overall performed by trainees and suggest that there may not be enough cases to become adequately trained to perform the surgery independently. Oddly, only half of the cases at the public institution were performed in full or part by residents which suggests that training exposure could be increased by having the trainees perform more of the cases as trainees skills allow. Also the ability to perform trabeculectomy independently is based more on general ophthalmic surgical skills which can be learned performing other types of cases. In fact, part of the reason trabeculectomy numbers may be decreasing may be related to increasing numbers of other procedures being performed, some of which require the same skill set in the operating theater. The difficult part of trabeculectomy is the postoperative care and more than one trainee can be involved in the care of a single case which also increases training opportunities. The surprising results of this study come in the comparison between generalists and glaucoma specialists with fairly similar rates of success. This may be due in part to patient selection bias or a system issue that cases may be followed the same way by the same physicians regardless of who performs the cases. Since success may be based at least as much on postoperative care as intraoperative technique the results may not be generalizable to other systems or locations. Either we find a cost effective way to train enough glaucoma specialists to perform every trabeculectomy or the educational opportunities that do exist need to be fully exploited to ensure an adequate supply of surgeons capable of performing trabeculectomy.

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