Photo from Unsplash
Originally Posted On: https://bluefinvision.com/blog/training-cataract-surgeons-responsibly-without-compromising-patients/
Cataract surgery is one of the most performed operations in modern medicine, with consistently high safety and success rates when delivered within structured systems of training, supervision and audit. Because of its frequency, cataract surgery is also a cornerstone of surgical training, and that reality makes patient protection, consent and supervision critical.
Much of my training and supervisory work takes place in high-volume training environments such as SpaMedica, where governance structures, outcome monitoring and patient safeguards are clearly defined. Regardless of setting, one principle always applies:
Patients come first.
Training is a close second.
Patient Choice Is Explicit and Respected
Patients listed on training pathways are always asked whether they are happy for a registrar to perform their cataract surgery under consultant supervision, in line with UK professional and ethical guidance.¹ ²
This discussion is led by an experienced member of the nursing team to ensure clarity, neutrality and the absence of pressure.
- Patients who are happy for a registrar to operate proceed on a supervised training list.
- Patients who prefer their consultant to perform the surgery are scheduled accordingly.
No explanation is required. There is no persuasion.
The patient’s preference is final.
Respecting patient autonomy is not an administrative detail; it is a fundamental part of safe surgical practice.
What Consultant Supervision Actually Means
Training does not mean abdication of responsibility.
When a registrar performs cataract surgery under my supervision:
- I am present in theatre
- The entire operation is observed live via the operating microscope feed on a large high-definition monitor
- Guidance is provided throughout the procedure
- I am able to intervene immediately if required
In some cases I may be scrubbed; in others, observation via live video allows clearer oversight and more effective teaching. What matters is not physical proximity, but continuous consultant responsibility and situational awareness.
National audit data demonstrate that cataract surgery performed by appropriately supervised trainees has comparable safety outcomes to consultant-performed surgery, provided case selection, supervision and escalation thresholds are robust.³ ⁴
Patients First. Training Second.
There is a persistent misconception that surgical training and patient safety are in conflict. Well-structured, closely supervised training improves long-term patient outcomes by producing surgeons who are safer, calmer and better prepared for independent practice.
However, this only holds true when priorities are explicit:
- Patient safety and preference always come first
- Training is structured and supervised
- Consultants remain accountable throughout
As one registrar recently wrote:
“Thank you for being such an exceptional cataract surgery trainer. Your mentorship has been truly transformative.”
Another reflected on confidence and decision-making rather than speed:
“Your mentorship has been truly transformative, particularly in the confidence you have helped me develop in myself as a surgeon.”
In cataract surgery, confidence must be earned, and closely supervised, not assumed.
Every Operation Is Recorded
All cataract procedures performed under my supervision, whether by me or by a registrar, are fully recorded.
Routine video recording supports:
- Clinical governance and accountability
- Structured post-case feedback
- Reflective learning and quality improvement
There is increasing evidence that video review improves consistency, insight and teaching quality across surgical specialties. Recording also reinforces transparency, for trainees and consultants alike.
Why This Matters
Cataract surgery will remain one of the most important operations in healthcare for decades to come. The surgeons of the future must be trained to the standards patients rightly expect today, not a diluted version of them.
That requires:
- Clear and informed consent
- Direct consultant supervision
- Outcome monitoring and audit
- A culture of feedback, not bravado
As one trainee summarised at the end of a placement:
“Training under you has been incredibly valuable, and I’ve genuinely enjoyed working with you.”
Enjoyment matters.
Standards matter more.
A Professional Responsibility
Training the next generation of cataract surgeons is both a privilege and a responsibility. Done properly, it strengthens the specialty and safeguards patients long into the future.
But it must always be done transparently, ethically and without compromise.
Patients come first.
Training follows – closely, carefully, and under constant supervision.
One of the registrars I was involved in training later went on to perform my own cataract surgery successfully, and I was the direct beneficiary of that training.
References
- General Medical Council. Decision making and consent. London: GMC; 2020.
- Royal College of Ophthalmologists. Ophthalmic Services Guidance: Consent for Ophthalmic Procedures. London: RCOphth; 2018.
- Narendran N, Jaycock P, Johnston RL, et al. The Cataract National Dataset electronic multicentre audit of 55,567 operations: risk stratification for posterior capsule rupture and vitreous loss. Eye (Lond). 2009;23(1):31–37.
- Johnston RL, Taylor H, Smith R, Sparrow JM. Outcomes of cataract surgery performed by supervised trainees. Br J Ophthalmol. 2010;94(9):1260–1264.
