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Weight-adjusted caffeine and β-blocker use in novice versus senior retina surgeons: a self-controlled study of simulated performance

Eye volume 37, pages 2909–2914 (2023)Cite this article

Subjects

Abstract

Background/Objectives

Tremor and expertise are potentially influenced variables in vitreoretinal surgery. We investigated whether surgeon experience impacts the association of microsurgical performance with caffeine and β-blockers weight-adjusted intake.

Subjects/Methods

Novice and senior surgeons (<2 and >10 practice years, respectively) were recruited in this self-controlled, cross-sectional study. A simulator’s task sequence was repeated over 2 days, 30 min after the following exposures: day 1, placebo, 2.5 mg/kg caffeine, 5.0 mg/kg caffeine, and 0.6 mg/kg propranolol; and day 2, placebo, 0.2 mg/kg propranolol, 0.6 mg/kg propranolol, and 5.0 mg/kg caffeine. Outcomes were total score (0–700, worst-best), simulation time (minutes), intraocular trajectory (centimeters), and tremor-specific score (0–100, worst-best).

Results

We recruited 15 novices (9 men [60%], 1.33 ± 0.49 practice years) and 11 seniors (8 men [72.7%], 16.00 ± 4.24 practice years). Novices performed worse after 2.5 mg/kg caffeine and improved following 0.2 mg/kg propranolol in total score (557 vs. 617, p = 0.009), trajectory (229.86 vs. 208.07, p = 0.048), time (14.9 vs. 12.7, p = 0.048), and tremor-score (55 vs. 75, p = 0.009). Surgical performance improved with propranolol post-caffeine but remained worse than 0.2 mg/kg propranolol in total score (570 vs. 617, p = 0.014), trajectory (226.59 vs. 208.07, p = 0.033), and tremor-score (50 vs. 75, p = 0.029). Seniors’ tremor-score was lower after 2.5 mg/kg caffeine compared to 0.2 mg/kg propranolol (8 vs. 37, p = 0.015). Tremor-score following propranolol post-caffeine remained inferior to 0.6 mg/kg propranolol alone (17 vs. 38, p = 0.012).

Conclusion

While caffeine and propranolol were associated with performance changes among novices, only tremor was affected in seniors, without dexterity changes. The pharmacologic exposure impact on surgical dexterity seems to be offset by increased experience.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

MR reported receiving research funding from Lemann Foundation, Instituto da Visão, Latinofarma, and Coordination for the Improvement of Higher Education Personnel. PLG reported receiving research funding from Research to Prevent Blindness and gifts from the J. Willard and Alice S Marriott Foundation, the Gale Trust, Herb Ehlers, Bill Wilbur and Rajandre Shaw, Helen Nassif, Mary Ellen Keck, Don and Maggie Feiner, and Ronald Stiff. MM and RB Jr reported receiving research funding from National Council for Scientific and Technological Development. The abovementioned institutions had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, or review of the manuscript.

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Authors and Affiliations

  1. Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil

    Marina Roizenblatt, Vinicius da Silveira Saraiva, Mauricio Hiroshi Nakanami, Luciana da Cruz Noia, Sung Eun Song Watanabe, Erika Sayuri Yasaki, Renato Magalhães Passos, Octaviano Magalhães Junior, Rodrigo Antonio Brant Fernandes, Francisco Rosa Stefanini, Rafael Caiado, Michel Eid Farah, Rubens Belfort Junior & Mauricio Maia

  2. Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil

    Marina Roizenblatt, Vinicius da Silveira Saraiva, Renato Magalhães Passos, Michel Eid Farah, Rubens Belfort Junior & Mauricio Maia

  3. The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Marina Roizenblatt & Peter Louis Gehlbach

  4. Kaiser Permanente Medical Group, McLean, VA, USA

    Kim Jiramongkolchai

  5. Department of Ophthalmology and Visual Science, University of Wisconsin School of Medicine, Madison, WI, USA

    Mitchell Wolf

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  1. Marina Roizenblatt
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Contributions

MR was responsible for designing the protocol, extracting and analyzing data, interpreting results, drafting the manuscript, and supervising the study. PLG, KJ, MW, ME, RBJ, and MM were responsible for designing the protocol, analyzing data, interpreting results, reviewing the manuscript for important intellectual content, and supervising the study. VSS, MHN, LCN, SESW, ESY, RMP, OMJ, RABF, FRS, and RC were responsible for conducting the search, extracting data, reviewing the manuscript for important intellectual content, and approving the final version of the manuscript to be published.

Corresponding author

Correspondence to Marina Roizenblatt.

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Roizenblatt, M., Gehlbach, P.L., da Silveira Saraiva, V. et al. Weight-adjusted caffeine and β-blocker use in novice versus senior retina surgeons: a self-controlled study of simulated performance. Eye 37, 2909–2914 (2023). https://doi.org/10.1038/s41433-023-02429-8

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  • DOI: https://doi.org/10.1038/s41433-023-02429-8

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