6 minute read
Finding Magic in Medicine
By Kimberly Hsu, DVM, MSc, DACVO
As veterinarians, we share the goal of improving the quality of life of our patients and of strengthening the human animal bond. For me, as a veterinary ophthalmologist, cataract surgery has always represented my opportunity to, no pun intended, make a visible difference for a patient and their family. As I’ve progressed in my career, this surgery has continued to capture my imagination, challenge me, and inspire me.
Getting My Start: Chasing Magic and Happy Endings
It’s cliché, but the day I decided on Ophthalmology specialization was the day I watched my first cataract surgery. It was the first week of clinical rotations during my final year of veterinary school. I remember marveling in the beauty of the swirling, cloudy lens fragments being aspirated out of the eye. It felt like magic and medicine had collided, restoring clarity and vision almost instantly. Furthermore, the transformation in our patient – from the nervous, tentative dog at drop-off to the tail-wagging, exuberant dog at pick-up – was dramatic and humbling. That moment where a previously blind dog recognizes its owner and leads the way towards them is nothing short of amazing. I knew that day that my calling in veterinary medicine was going to be to facilitate more joyous reunions.
Taking Flight: Finding My Breath
I remember my first complete cataract surgery vividly. Much like playing scales on the piano, I had spent my entire first year of residency practicing each component step of surgery over and over. Despite this, under the magnification of the operating microscope, the trembling of my hands resembled a small earthquake. I tried breathing deeply. When that didn’t work, I tried holding my breath. Somehow, in spite of my nerves, I was able to successfully remove the cataract and place an intraocular lens implant. I think through the intensity of my focus, I forgot to stop and appreciate the significance of the moment. It finally hit me when to celebrate: our ophthalmology technicians made me a nametag sticker that stated in bold letters “I did my first cataract surgery today,” beside which they pasted a purple dog with big googly eyes. It felt like a literal badge of honor, and I wore it proudly.
Holding Steady: Self-Care for the OR
With time and practice, I have learned to steady my nerves and my hands. Similar to in a yoga class, during critical steps of surgery, I am acutely aware of my breath and can now control it even in moments of stress. We have all heard, particularly in times like these, that self-care translates into better patient
EXPERT TIP: Are there cataract emergencies? Although many cataracts are slowly progressive and elective cataract surgery can usually be scheduled without urgency, there are exceptions. Cataracts that are rapidly forming, intumescent or ruptured, such as those in young dogs or diabetics, often require aggressive medical treatment and prompt surgical removal.
Like many in our profession, I am an admitted type A perfectionist. I have worked hard to get to where I am largely by working a little harder and a little longer sometimes pushing through exhaustion. This was especially true in my final year of residency preparing for my board exam, emerging from under my mentor’s wing, and learning to be a new mom. My life then, and admittedly sometimes now, was fueled by sheer determination and a lot of caffeine. Cataract and microsurgery days had to be different though. From a very early stage in my career, I learned that in order to bring my best self to microsurgery, I needed to be well nourished, rested, and relaxed. Of these, sleep is the most critical and one where there just are no shortcuts. I sometimes think that my husband ought to be awarded some sort of prize for best supporting actor in my microsurgical career. Since the beginning, he has facilitated getting a full night’s sleep before surgery days despite the erratic sleep patterns of our tiny humans. Ultimately, I think that the lessons learned from microsurgery extend beyond the OR.
Changing Perspectives
Like most newly minted DACVOs, I graduated residency wanting to be exactly like my mentors, for whom I have the utmost respect and admiration. I spent my first two years as a diplomate doggedly trying to replicate their approach to cataract surgery. This utilizes what is termed one-handed cataract surgery, a technique which is widely used across veterinary ophthalmology. To reuse the music analogy, I was like a piano student pounding out the same concerto over and over again. In this case, it was through a single incision utilizing one instrument at a time. I worked hard at my craft, and over time, gained speed and consistency.
Then, about two years after achieving Diplomate status, everything changed. My practice had just upgraded from an older, refurbished phacoemulsification machine to a new unit that is state of the art in both human and veterinary medicine. With this new unit, I had much greater control over machine parameters, which I could manipulate in an instant. Around this time, I had the great privilege of hearing Dr. Barry Seibel, a renowned MD ophthalmologist, deliver a lecture on phacodynamics. Dr. Seibel explained that with an understanding of lens anatomy and of the forces exerted by the surgeon and machine during cataract surgery, we are able to more efficiently break up a cataractous lens. This required a two-handed approach to cataract surgery. Although a second tiny corneal incision is required, use of a second instrument enables the surgeon to mechanically break up part of the lens, thus reducing the amount of ultrasound energy needed. The use of a second instrument also enables the surgeon to apply less stress to the fragile lens capsule, which envelops the lens, and to the thin zonular fibers, which tether the lens in place. Dr. Seibel argued that infusion, aspiration and ultrasound energy should be customized to the patient and to the task at hand. In the span of a two-hour lecture, it became clear to me that I needed to broaden my approach to cataract surgery.
Changing My Tune
I bought Dr. Seibel’s textbook the instant I landed at home, and spent the next 6 months studying it. Shortly thereafter, I began attending human ophthalmology conferences as well as working with a wonderful local MD ophthalmologist. Watching and training with MD ophthalmologists was like falling in love with cataract surgery all over again. This time, the part that was captivating was in dissecting the surgeon’s approach. When the best human ophthalmologists perform cataract surgery, each movement is purposeful, deliberate, and perfectly coordinated with machine settings.
Applying the principles I’ve learned since residency have proven to be a game changer for challenging and higher risk cases. I love the process of planning my approach for the exact case at hand, and now have more tools to utilize when challenges present at the time of surgery. I feel like a pianist who, by understanding the basics of music theory, can now create new harmonies and even take the piece off script, so to speak, when needed.
The Journey Continues
I do not think that as I sat, awestruck watching my first cataract surgery, that I ever could have imagined the incredible journey this surgery would take me on. For me now, cataract surgery has many more dimensions than when I first started. It is equal parts strategy, technique, challenge, fun, and inspiration. This is where I feel I’m living my best life professionally and where I continue to evolve as a veterinary ophthalmologist. I remain humbled and inspired to have found such an incredible opportunity to weave both mastery and magic into my medicine. Cheers to many more joyous reunions and happy endings!
About the Author: Kimberly Hsu, DVM, MSc, DACVO, is a veterinary ophthalmologist practicing at Blue Pearl in Malvern, PA. She is passionate about raising the bar, bringing new techniques into the veterinary space. She is one of only a few veterinarians accepted into the American Academy of Ophthalmology and trained to perform retinal reattachment surgery. Dr. Hsu can be reached at 610.296.2099 or kimberly.hsu@bluepearlvet.com.
