Vision & the Ageing Surgeon: A Review

Populations in the developed world are ageing and their surgeons are no exception. Accurate vision is essential for the surgeon to operate effectively, yet optimal vision has an expiry date in advancing age. This review examines the effects of ageing on the eye with particular focus on the visual changes of significance to senior surgeons who currently account for 20%-25% of the surgeon workforce. The major age-related diseases of the eye, which include cataracts, glaucoma, age-related macular degeneration and diabetic retinopathy, are surmised; together with physiologic ocular changes that accompany normal ageing, including loss of accommodation (presbyopia), reduced pupil size (senile miosis), reduced contrast sensitivity, and impaired binocular vision, amongst others. The aforementioned conditions may impair operative visualisation in the elderly surgeon and potentially impact surgical performance. Strategies and available technologies that support operative visualisation-particularly magnification aids, illumination systems and fluorescent dyes in surgery-are appraised with consideration to the senior surgeon who may be affected by the aforementioned visual changes associated with ageing. To inform minimum standards of visual function for safe surgical practice, future prospective studies are needed which report on individual surgeon-related measures of visual function together with postoperative outcomes. This vein of future research will allow for an evidence-based evaluation of proposed safety measures for which the data are currently lacking, thereby providing clarity regarding whether requisite age-based visual assessments improve surgical outcomes, and if so, at what age and frequency should such evaluations take place.