For many years going to meetings where phacoemulsification (cataract surgery) machines were discussed was an unrewarding experience. Very few ophthalmologist colleagues understood how their machines worked, and their lectures reflected that. Beginning in the mid 1980’s a few of us began to try to teach our colleagues how phacoemulsification works, with limited success. And then, in 1993, the landmark Phacodynamics book, by Barry S. Seibel MD, appeared. Finally, a reference was available to teach surgeons how their machines worked, and how to use them more effectively and safely. Almost before the ink was dry, Dr. Seibel was asked to write a second, then third, then fourth edition, then 5th …
The essence of phacoemulsification is to adjust the surgical environment and phaco machine parameters, so that to the observer, every cataract procedure appears to go easily and the same, whether the surgeon is dealing with a very dense nucleus, pseudoexfoliation, Flomax induced intraoperative floppy iris syndrome, or a myriad of other potential problems. Dr. Seibel has studied phaco machine design and designed specialized instruments to facilitate the tailoring of every unique operation to make it proceed as flawlessly as possible. It is an evolution of the art of surgery achieved by few and not a simple process. Try putting on a pair of skates and emulating the best ice dancers. That is the kind of skill and knowledge needed to achieve ophthalmic surgical excellence and is what Dr. Seibel demonstrates as well as teaches (admirably well).
With respect, to my great partner in science,
Steve Arshinoff MD FRCSC
Department of Ophthalmology and Vision Sciences
University of Toronto, Canada.
Affirmation by one’s peers is a powerful achievement and strong predictor of future performance. I had the enriching experience of witnessing a spontaneous peer surgeon assessment of Dr. Barry Seibel while he performed cataract extraction surgery and implanted an intraocular lens.
Dr. Seibel is a highly regarded cataract surgeon and acknowledged expert in “Phacodynamics,” (technology used during cataract surgery), having written four editions of the definitive textbook on this subject that he invented. Because of his expertise and experience Dr. Seibel was chosen to participate in an evaluation of new technology designed to enhance cataract extraction surgery. Use of the new technology required new modifications of the surgical approach for its proper use. On this particular occasion there were five other highly regarded cataract and refractive surgeons present in the operating room who observed Dr. Seibel performing the surgery by watching magnified images on video monitors installed within and outside the operating room. The patient’s cataract was hard and dense.
You could have heard a pin drop while everyone present in the operating room observed a master solve each surgical challenge and execute each surgical maneuver with elegance and confidence that was achieved with his laser- like focused attention and deep knowledge of every step of the procedures. There were no unnecessary steps and each step was choreographed to be performed efficiently and carefully. He made the complex appear easy. Near the conclusion of the successful surgery and in unison, all five surgeons spontaneously applauded the work they had just seen. Dr. Seibel was oblivious to this accolade, because he was still absolutely focused on the patient and unwilling to be distracted. I had the distinct pleasure of telling him afterwards.
George Marcellino, PhD
Ophthalmic Industry Executive
While technological advances have elevated phacoemulsification [cataract] surgery to a higher level than ever, such progress unfortunately comes at the expense of simplicity. It is now more complicated than ever to program a phaco machine. For some, it may seem like it could occupy an entire career just trying out the many possible permutations and combinations of settings.
Fortunately, through his textbook, Barry Seibel is there to shepherd us through the gauntlet of confusing terminology and to help us navigate the ever-expanding array of Phacodynamic features. This is the fourth edition of his classic textbook, and one can gauge the tremendous progress of phaco technology through the years by measuring the increasing thickness of each successive edition. As in the previous editions, Dr. Seibel demonstrates his unique gift for being able to simplify complex engineering concepts to a clinically understandable and practical level. His signature style of illustration gives us stepwise visual tools to understand what is otherwise happening too rapidly in real time.
For the surgeon willing to invest the time and effort in mastering Phacodynamics, there is a compelling reward—that of being able to better harness modern technology toward improving efficiency, and decreasing complications with difficult cases.
David F. Chang, M.D.
Past Chairman, American Academy of Ophthalmology Annual Program Committee
Foreword (abridged) to Phacodynamics, 4th Edition.
I worked very closely with Dr. Seibel for several years in developing the Catalys Precision Laser System. We approached him because of his distinguished reputation in the field of cataract and refractive surgery. After all, he wrote the book on Phacodynamics (the clinical application of engineering principles in cataract surgery). We believed that Dr. Seibel’s unique combination of surgical skill and thorough understanding of the processes involved in cataract removal would be a boon for our project. We were right. Together we produced a system that tailors treatment for each eye of each patient with outstanding results. That would have been enough, but he provided us even more. Dr. Seibel’s immersive approach to medicine treats not only each patient as an individual but each of their eyes as well, which truly sets him apart as a physician, a surgeon, and a colleague.
“Many cataract surgeons owe their understanding of modern cataract surgery (called phacoemulsification) to Dr. Seibel’s teachings. It is because of his excellent surgical skills, combined with his ridiculously high IQ, that he is able to teach other surgeons. I, myself, am in debt to his teachings and consider myself fortunate to share a community with him.”
– Dr. David Richardson
Fellow eye surgeon in community
As a professor of ophthalmology at the University of North Carolina, School of Medicine, I am responsible for the surgical training of novice, ophthalmology residents. A novice surgeon must follow the “rules.”
For the education of my ophthalmology residents, I totally rely on Dr. Seibel’s textbook. Dr. Seibel has complied a complete set of rules for advanced, modern cataract surgery. His textbook is a masterful explanation of the physics of the technology of the phacoemulsifiers (cataract surgery machines).
The genius of Dr. Seibel’s textbook is what follows: how the physics of the technology affects specific operative maneuvers, positively or negatively, thus defining the issues one needs to think about for each stage of the operation.
The usefulness of Dr. Seibel’s book does not stop with the teaching of the novice surgeon. Competent/Proficient/Expert surgeons realize that each operation is different and advances in operative technique continue to evolve. Surgeons at these levels make intraoperative decisions holistically. For these nuances, Dr. Seibel’s book allows integration of the physics of phacoemulsification technology into these advances, for improved patient outcome.
Phacocynamics, Mastering the Tools and Techniques of Phacoemulsification Surgery, is the best complete source for beginner, intermediate, and advanced surgeons.
Kenneth L. Cohen, MD
Sterling A. Barrett Distinguished Professor of Ophthalmology
University of North Carolina at Chapel Hill
School of Medicine
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