The third iteration of GenEye took place for the first time in the fabulous facilities of the world leading and newly created education precinct at the Royal Victorian Eye and Ear Hospital, overlooking St Patrick’s Cathedral, the Melbourne Cricket Ground, and beyond to the Dandenong ranges.
The brainchild of Dr Jacqueline Beltz, this annual hands-on learning experience is invaluable for optometrists, trainee doctors, ophthalmology registrars, and experienced consultant surgeons.
GenEye was born out of a desire to revolutionise the way we learn and grow. As Dr Beltz explained in her opening address, its organisers recognise that the traditional lecture format – often dominated by PowerPoint slides – is not the most effective way to foster deep learning and skill development. Instead, GenEye focusses on experiential learning – by doing, by observing, and most importantly, by engaging in meaningful conversations with peers.
This is a conference “committed to taking care of ourselves and each other, ensuring that we are at our best to provide the highest level of care for our patients”, she said.
As such, workshops emphasised a holistic approach, integrating mind, body, and skills training to achieve high performance, deeply rooted in the concept of continuous improvement: By striving to be just 1% better each day, we can collectively achieve extraordinary progress over time. Most participants were probably more than 1% improved from this amazing, immersive experience!
In delivering GenEye, Dr Beltz was joined by a number of equally invested faculty members, including ophthalmologists Alison Chiu, Ben Au, Lukas Sahhar, Rahul Chakrabarti, Stephanie Tiew, Danielle Buck, Colby Hart, Lana Del Porto, and Jamie Chew. They generously dedicated their time over the three days to support all of us – from inexperienced novices through to experienced surgeons. In essence, this remarkable group made learning fun, as it should be.
BASIC TRAINING
Day one was reserved for a mix of around 30 eye and ear registrars, trainee doctors, and nine optometrists. Small groups were rotated through several workstations to be trained in basic suturing of artificial skin wounds, advancing to micro-suturing techniques on artificial corneas; foreign body removal; and the use of forceps, cutters, operating microscopes, foot pedals, and more.
A number of trainee doctors reported that even if they never progressed into ophthalmology, their new-found ability to do better, finer suturing would benefit them greatly, even in general practice, along with foreign body removal and a greater understanding of cataract surgery.
Training ramped up to virtual, but very realistic anterior segment surgery techniques. This was achieved via the VRmagic eyesi surgery simulator, inserting instruments through physical ports into a virtual anterior chamber and viewing realistic iris, lens, and capsule features, via a simulated image in the operating microscope. Various instruments and surgical scenarios could be virtually selected to teach the requisite skills of working through a port and operating with delicate movements. For beginners this was as simple as tracing an outline for a capsulorhexis or touching specific points on the lens surface. On screen, trainers and observers could see exactly what delegates were doing and seeing, offering advice as needed. All this helped trainees develop basic fine motor skills and dexterity – so critical in eye surgery.
In another surgical lab, realistic artificial eyes were used to train intraocular lens (IOL) implantation using instruments and microscopes. We learned to cut and explant with realistic ports, corneas, and ciliary bodies, with complete fluid-filled anterior chambers, injection of real viscoelastic, and so on. This was an amazing experience for beginners and trainee surgeons. I was blown away by the experience of doing my first IOL – a real buzz, akin to what I experienced from skydiving.
Experienced surgeons were of course given more challenging anterior segment surgical tasks.
Such virtual surgical training was pioneered at Victoria Eye and Ear a few years back. It was so successful that all ophthalmology registrars in Australia and New Zealand are now required to show competence in these techniques before being let loose on real patients.
PATIENT INTERACTION
In a room adjacent to one of the surgical training theatres, trainees interacted with professional patients, ‘priming’ them for their IOL surgery in a ‘pre-op’ session, covering risks and procedures, and addressing concerns and questions, while explaining concepts via computer images, pamphlets and so on. At a later stage, the professional patients were seen in ‘post-op’ review sessions where any issues and symptoms were addressed – along with eye drop use, recovery time, next steps and the like. The professional patients were well versed on challenging the trainees, getting them to think on their feet and explain the various scenarios raised. Valuable lessons for all concerned.
MAINTAINING OUR COOL
Adding another dimension to the day was a group of experts in sports physiology, performance, and psychology. They taught us breathing and other relaxation techniques and assessed our level of relaxation, by measuring heart rate and so on as we simulated surgical procedures. Delegates were asked to rate their subjective intensity of disturbance or distress before, during, and after these procedures, then make comparisons with the subjective units of distress scale (SUDS). The simulation software in turn measured and recorded every tremor and error made, as we traced, for example, capsulorhexis patterns and much more.
During this session we were also shown how to set up for correct posture while working at a desk, on computers, slit lamps, and operating microscopes, as well as some exercise techniques to prevent and manage neck and back issues.
ADVANCED SURGICAL TRAINING
Days two and three of GenEye were reserved for even smaller groups of around a dozen advanced ophthalmology trainees, consultant surgeons, and registrars. Surgeons completed the workstations and labs from day one at a far more advanced level, finding themselves thrown into challenging situations like ruptured capsules, zonular dehiscence, triamcinolone injections, vitrectomies, and related ports.
Although participants were focussed while performing the surgeries, everyone was smiling and relaxed, enjoying the opportunities at hand and taking advantage of the support provided.
BUT WAIT, THERE’S MORE!
Throughout the three-day event, participants were able to gain experience using the remarkable Alcon Ngenuity threedimensional (3D) visualisation system. This is essentially a 3D operating microscope visualised on a large screen, through 3D polarised filters. The system, which allows for improved posture and more relaxed operating, was surprisingly intuitive and easy to use. One very tall surgeon – who has to operate in less-than-ideal postural positions with traditional optical microscopes – was very interested. Alcon also had its phaco system on display, offering training, further surgical demonstrations, and video techniques as well as 3D virtual reality headsets coupled to digital hand controllers to perform super realistic virtual, simulated capsulorhexis, and other anterior segment procedures. Fantastic stuff.
FUTURE FOCUS
Ophthalmologist Dr Jamie Chew, one of the founders and developers of i-scribe, Australia’s only Al powered medical scribe, was on hand to demonstrate this great system. I was impressed by the accuracy and ease of use in a simulated consult we performed, with it getting some complex words spot on (e.g. forme fruste keratoconus, and moxinidene), and accurately notating a spectacle Rx with sph, cyl, axis, add and visual acuities, in standard format.
In this simulated environment, i-scribe created an exact transcript of all that was said by the doctor and patient. A bullet-pointed transcript summary and referral report were simultaneously and automatically created.
We experienced only one easily fixed error – caused by my funny accent. ‘Flecked retina’ was recorded as ‘fleck Dreitner’. Bear in mind this took place in a noisy room with many people talking in the background and was recorded via a built-in laptop microphone. We taught i-scribe the correct term with a simple click of the mouse. Learning from this scenario, it immediately updated the term in all instances.
No doubt many eye health professionals will soon be using such time-saving scribe suites in their daily work.
To wrap up the holistic approach and mind/ body experience, delegates were invited to participate in a relaxing session in the ‘Mind Lab’, complete with bean bags. Here they were taught – and experienced – relaxation, mindfulness, and meditation techniques.
Dr Beltz concluded by saying, “Part of the GenEye philosophy is that we need downtime. For most of us this happens on weekends. We see surgical education as a work thing and aim to keep it within work hours. We understand that this comes with consequences. So, thank you for clearing your schedules. Your presence and enthusiasm make GenEye a truly unique and impactful experience”.
Alan Saks is a retired optometrist. He is the Chief Executive Officer of the Cornea and Contact Lens Society of Australia, and a regular contributor to mivision.
