Convergence insufficiency: a treatable cause of problems in microsurgery

Microsurgical training concentrates on the practical mechanisms of performing vessel anastomoses, with little attention given to medical problems that may adversely affect the trainee's performance. Undiagnosed vision problems are rarely considered in microsurgical training, and may not be manifested until other limiting factors, such as basic instrument and suture handling, are mastered. While vision problems tend to be diagnosed and treated immediately among ophthalmology trainees, visual and ocular pathology is poorly understood outside of that specialty. We present a case of a surgeon who had been performing microsurgery for 10 years with an undiagnosed binocular vision problem that consistently affected microsurgical proficiency. Once diagnosed, the problem responded to therapeutic exercises within weeks. We suggest ophthalmologic referral of any surgeon who has unexplained problems with microsurgical technique (especially problems involving stereoscopic vision) to exclude a treatable visual cause.