Phaco looks easy when you’re watching from the sidelines. The probe moves smoothly, the nucleus splits perfectly, and the case is over in minutes. But when it’s your turn, everything feels different.
The foot pedal doesn’t respond the way you expect.
The nucleus doesn’t crack cleanly.
The phaco tip feels heavy and awkward in your hand.
Every move feels slow, clumsy, and frustrating.
And the worst part? It feels like everyone else is getting better except you.
If you’re struggling with phaco, you’re not alone. Every surgeon has been exactly where you are now.
But here’s what no one tells you:
1. Struggle Is Normal—But Only If You’re Actually Learning From It
Many beginners assume that struggling in surgery means they’re just “bad” at it. That’s not true.
Struggle is a sign that you’re pushing yourself beyond your comfort zone—which is the only way to improve.
But here’s the catch: Repeating the same mistakes without analyzing them means you’re just reinforcing bad habits.
What to do instead:
#Review your cases—don’t just move on after a bad surgery. Ask yourself:
- Where exactly did I struggle?
- What part of the case slowed me down?
- Was it technique, machine settings, or my own hesitation?
#Watch videos of similar cases after surgery, not before. You’ll absorb more when you’ve already struggled through the problem yourself.
#Take one lesson from each case—and apply it in the next one.
2. The Machine Is More Important Than You Think
Most beginners blame their surgical technique when things go wrong. But often, it’s their poor understanding of the phaco machine that’s messing them up.
You can’t move smoothly if you’re constantly thinking:
- Which foot pedal stage am I in?
- Is my vacuum too high?
- Why is the chamber unstable?
What to do instead:
#Learn your machine inside out— outside the OT. Experiment with settings before surgery so you aren’t figuring them out mid-case.
#Get used to foot pedal control without using your hands. The pedal should be an extension of your body.
#Ask seniors about their settings—but don’t copy them blindly. What works for them might not work for you.
3. Stop Being Afraid of the Probe—Own It
One of the biggest beginner mistakes? Holding the probe like it’s a fragile object instead of a tool that they control.
- You hesitate while inserting the probe, making wound burns more likely.
- You don’t hold the phaco tip firmly enough, so the nucleus moves instead of cracking.
- You move too cautiously inside the chamber, making your surgery inefficient.
What to do instead:
#Grip the probe firmly—don’t let it control you.
#Commit to each move. A hesitant crack is worse than a strong, slightly off-center one.
#Don’t hover. Get to the nucleus, engage it, and move purposefully.
4. You Don’t Have to “Prove” Yourself in Every Case
A hidden fear among beginners? That seniors or OT staff will judge them.
This leads to:
- Rushing through steps just to appear fast.
- Refusing to ask for help because they don’t want to look weak.
- Avoiding surgeries altogether because they don’t want to mess up in front of others.
The result? They learn slower than they should.
What to do instead:
#Forget about proving yourself. Surgery is a skill—not a talent contest.
#Ask for help when needed. Even seniors do this.
#Slow down—but with confidence. A deliberate surgeon always looks better than a rushed, panicked one.
5. The First 100 Cases Are About Survival—Mastery Comes Later
No one tells you this, but in your first 100 cases, you’re not supposed to be great at phaco. You’re just supposed to survive and get better each time.
Every surgeon struggles at the start. But the ones who improve are the ones who keep showing up.
What to do instead:
#Stop expecting yourself to be “good” at phaco yet. Just focus on improving one thing at a time.
#Don’t compare yourself to seniors. Compare yourself to where you were 10 cases ago.
#Keep taking cases—even when you’re frustrated. The only way out of the struggle is through it.
Final Thought: Struggle Means You’re on the Right Path
Phaco is hard at first for everyone. The only difference between the surgeons who improve and those who stay stuck is who keeps going.
If you’re struggling, good. That means you’re learning.
Just make sure you struggle in the right direction.