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Spotlight: Simulated Eye Surgery Equals Real Learning

By Gary Goldenberg

Donors and alumni turn a vision into reality with a state-of-the-art surgical simulation center for ophthalmology residents

Anurag Shrivastava, M.D., an associate professor of ophthalmology and visual sciences and the assistant dean for Montefiore Medical Center, winces when he recalls the first time he operated on a living human eye.

He was a junior resident, and although he had observed cases and received a modicum of hands-on classroom training with rudimentary instruments and animal eyes, that preparation hadn’t given him much confidence. Having an experienced surgeon at his side, talking and assisting with each step, kept the patient safe—ultimately allowing Dr. Shrivastava to learn these skills over the course of his training.

“My heart was beating out of my chest,” he remembers. “I was excited, because this was something I’d been waiting to do for years. But it was very stressful—and potentially very dangerous for the patient.”

That first patient did just fine. Years later, however, when Dr. Shrivastava became director of the ophthalmology residency program at Montefiore, he vowed to modernize the way fledgling eye surgeons master their art and craft.

“The conventional approach to learning skills during residency was ‘see one, do one, teach one,’ as the old saying goes,” he says. “That’s an exaggeration, but we did dive right into the operating room with almost no formal training or preparation with simulators. That wasn’t a good approach in ophthalmology because of the complexity of the microscopic surgeries, combined with the extremely small margins of error.”

Even cataract removal—the most commonly performed eye operation—is dauntingly complex. The surgeon must coordinate four different controls (two for the hands and two for the feet) while peering through a microscope and operating on a delicate organ that can’t be completely immobilized. Further complicating the issue, patients, although sedated, are awake during surgery so that they can respond to the surgeon during portions of the procedure. It’s no wonder that Dr. Shrivastava’s first day in surgery was terrifying.

Above: Ana Rubin Panvini, M.D., resident ‘19, practices cataract extraction on an artificial eye with Anurag Shrivastava, M.D. At top of page: Jimmy K. Lee, M.D., Erin Walsh, M.D., Roy Chuck, M.D., Ph.D., and Rob Fargione, M.D., resident '17.
Members of the Class of 2018 practice intraocular implants. From left are Rachel Shah, M.D., Poonam Misra, M.D., Ryan Gise, M.D., and Isaac Chocron, M.D.

Simulated Surgery

Today, before ever wielding a scalpel in the operating room, junior ophthalmology residents at Montefiore spend months cutting, repairing, and suturing in the laboratory. This is no ordinary lab; it is a state-of-the-art digital classroom.

Officially known as the Ronald M. Burde, M.D., Surgical Simulation Laboratory, it features real operating microscopes and artificial eyes with remarkably lifelike movements and
anatomical structures, which, when used along with animal eyes, allow simulation of almost any ophthalmic procedure. The new laboratory is located in the Moses Research Tower on the Montefiore campus and named in honor of the late Dr. Burde, who chaired the ophthalmology department from 1988 to 2000.

“In ophthalmology, you have to perform a particular operation 150 to 200 times before you can master it,” says Roy Chuck, M.D., Ph.D., the Paul Henkind Chair in Ophthalmology, a professor and the chair of ophthalmology and visual sciences, and a professor of genetics. “The learning curve in the first 20 or 30 cases is very steep. Having residents do surgical simulations in the Burde Laboratory helps flatten that learning curve by quite a bit.”

Studies show that ophthalmology residents who train on simulators can reduce their real-life surgical complication rates by as much as 50 percent—to the great relief of patients and trainees alike.

“In the past, we usually couldn’t identify residents who were having problems until they went to the operating room,” Dr. Shrivastava says. “Now we can spot their weaknesses early and give them one-on-one training in the lab. They don’t move on to patients until they’re as ready as possible.”

As they progress through their three-year residencies, trainees graduate from simple eyelid procedures to more-complex intraocular operations, such as cataract extraction, corneal transplantation, glaucoma surgery, and strabismus repair—each of which they can simulate in the Burde Laboratory.

The Burde Laboratory also features a newly constructed multipurpose computer library and a teleconferencing facility, which allows Montefiore trainees to attend remote lectures and surgical demonstrations by leading surgeons from around the country. And Einstein faculty members in turn can share their expertise with the rest of the world. Combining these resources with a lecture portal that Dr. Shrivastava has under active development will put Montefiore ophthalmology at the absolute forefront of residency education, using technology that extends its reach beyond borders.

The Burde Laboratory will serve as the testing ground for the department’s Center for Ophthalmic Innovation, a novel effort to encourage advances in eye care. “When our faculty has ideas for developing new techniques and technologies or improving old ones, they’ll be able to test those ideas in the laboratory, apply them in clinical practice, and then refine them as needed back in the lab,” Dr. Chuck says. “No other ophthalmic microsurgery lab in the country is based on that concept.”

WATCH THE VIDEO

Meet a glassblower who underwent life-changing eye surgery.

Lectures and group-learning sessions take place in the Ronald M. Burde, M.D., Surgical Simulation Laboratory. At right is Arthur N. Hershaft, member of Albert Einstein College of Medicine’s Board of Trustees and supporter of the ophthalmology department.

Support From Alumni and Donors

Dr. Burde’s widow, Sharon, a longtime friend and supporter of the ophthalmology department, has been instrumental in developing the Burde Laboratory, attracting contributions from her husband’s colleagues and from former trainees all over the United States. Says Dr. Chuck: “They look back and realize that it would have been so much better if they didn’t have to learn on patients at the very beginning. Their support is a wonderful gift to the next generation of ophthalmologists, and a fitting legacy to a former department chair.”

Support for the Burde Laboratory has also come from business executive Arthur N. Hershaft. Some 50 years ago, he began experiencing vision loss because of central serous retinopathy, a condition in which fluids collect under the retina. Experimental laser treatments stabilized his eyesight, transforming him into an avid supporter of biomedical research and innovation. A Bronx native now living in Manhattan, Mr. Hershaft has a particular fondness for Einstein, where he has served on the Board of Trustees for more than a decade.

When Mr. Hershaft turned 80, friends asked him where they could make a donation in his honor. “I consulted [then-dean] Allen Spiegel for guidance, and he mentioned the department of ophthalmology,” he says. “I didn’t even know Einstein had such a department. I later learned it conducts a wide range of research and handles 150,000 patient visits a year—one of the largest caseloads in the nation. Few people know what the department is doing and its value to the community. It’s the biggest secret here.”

Mr. Hershaft’s philanthropy and that of his friends and family have helped the Burde Laboratory become an important innovation in medical education. They and their fellow donors have enabled the laboratory to train, teach, and prepare residents for careers in ophthalmology today and far into the future.

“When people ask me why I support Einstein,” Mr. Hershaft says, “I tell them that you can make a real difference here. You can get involved in any number of ways, and the decisions and contributions you make can directly shape the school. There aren’t too many medical institutions where you can have that kind of role.”

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