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Comment & Response
November 5, 2020

Studies of Microsurgical Skill—The Key Lies in the Design—Reply

Author Affiliations
  • 1Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
  • 2Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia, Paulista Medical School, Universidade Federal de São Paulo, São Paulo, Brazil
  • 3Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Ophthalmol. 2021;139(1):127-128. doi:10.1001/jamaophthalmol.2020.4758

In Reply We appreciate the interest of Drs Volovici and Dindelegan in understanding microsurgical performance. We acknowledge our distinct perspectives, including our consideration of caffeine and β-blocker use during microsurgery as a historical and present practice and the relative disparity in scale of our respective microsurgical tasks. We thank them for the opportunity to compare potential study designs.

Our work1 was directed at enhancing the safety of single-micrometer–scale procedures via multiple strategies, including standard stabilizing techniques, robotic assistance, physiological approaches, and pharmacological approaches. In our study,1 propranolol and caffeine use by junior microsurgeons was associated with measurable changes in surgical performance on a simulator capable of sensitive, quantitative, and objective measures. We shared these results with a physician audience, some of whom have used or are using caffeine and/or β-blockers in surgery—either incidentally or with an intention to enhance performance. To our knowledge, associations between simulator skills and clinically significant surgical outcomes have not been established.2

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