Surgeon stress management in cataract surgery
Seance of wednesday 10 june 2026 (Séance Académique d'Ophtalmologie : Chirurgie de la cataracte : les dernières évolution organisationnelles Bloc et Hors-Bloc et Robotique ( 1ères mondiales))
DOI number : 10.26299/g3kj-1g46/emem.2026.24.02
Abstract
Fighter pilots and competitive athletes benefit from coaching. Surgeons have no right to make mistakes and must learn to manage their mental workload on their own. This has consequences for both the effectiveness of the procedure and the surgeons’ health. Cataract surgery is microsurgery. Stress has an amplified effect, through the operating microscope, on fine precision and decision-making. Cataract surgery is the most commonly performed operation in the world. The quality of its results must not obscure its complexity, with zero tolerance for error.
Adrenaline, the sprint hormone, causes tachycardia, tunnel vision, and loss of communication. Cortisol mobilizes glucose reserves to maintain energy, which ultimately translates into fatigue. A certain level of adrenaline is nevertheless necessary to improve alertness, concentration, and precision. However, the efficiency curve declines more rapidly in novice surgeons depending on their stress level. Three techniques can help limit the effects of stress: a cognitive strategy consisting of planning and visualizing the procedure; broadening attention to fight tunnel vision through communication ; and finally, tactical breathing. This sends a message to the autonomic brain: I am in control of the situation. Experience transforms complex gestures into procedural automatisms, whereas unmanaged stress is paralyzing. A complex case will be perceived as a threat by a novice, as an effort by a trained surgeon, and as a challenge by an expert surgeon. The key takeaways are the need to plan rather than react, to observe a ritual, to know how to stop for a few seconds to break the cycle of panic, and to use tactical breathing and techniques to avoid tunnel vision. We should emphasize the importance of training, calm, communication, and finally, debriefing with the team. In conclusion, one does not learn to stop being stressed; one learns to perform better despite stress. It is important to take mental workload management into account in the training and selection of young surgeons.
Adrenaline, the sprint hormone, causes tachycardia, tunnel vision, and loss of communication. Cortisol mobilizes glucose reserves to maintain energy, which ultimately translates into fatigue. A certain level of adrenaline is nevertheless necessary to improve alertness, concentration, and precision. However, the efficiency curve declines more rapidly in novice surgeons depending on their stress level. Three techniques can help limit the effects of stress: a cognitive strategy consisting of planning and visualizing the procedure; broadening attention to fight tunnel vision through communication ; and finally, tactical breathing. This sends a message to the autonomic brain: I am in control of the situation. Experience transforms complex gestures into procedural automatisms, whereas unmanaged stress is paralyzing. A complex case will be perceived as a threat by a novice, as an effort by a trained surgeon, and as a challenge by an expert surgeon. The key takeaways are the need to plan rather than react, to observe a ritual, to know how to stop for a few seconds to break the cycle of panic, and to use tactical breathing and techniques to avoid tunnel vision. We should emphasize the importance of training, calm, communication, and finally, debriefing with the team. In conclusion, one does not learn to stop being stressed; one learns to perform better despite stress. It is important to take mental workload management into account in the training and selection of young surgeons.