My name is Atanas Bogoev, M.D., FEBO and I was fortunate enough to observe my colleagues in the Glaucoma and Advanced Anterior Segment Surgery program (GAASS observership) at the University of Toronto in Canada. I had the opportunity to be there, observing for 2 weeks in April 2023. Without a doubt, I can say, that the experience was one of the most memorable and valuable of my career by far.
Here I am going to share all about my experience, impressions, and what I learned below.
The GAASS Supervisors
In my brief experience, I can truly say that in addition to their outstanding professional backgrounds and expertise, the GAASS observership supervisors are very detail-oriented mentors and exceptional teachers.
Despite their busy schedules, advancing the skills, knowledge, and experience of their fellows was their main priority. They provide hands-on training and guidance throughout the fellowship program. I believe their down-to-earth approach and willingness to help their fellows advance make them highly respected and sought-after mentors in the ophthalmology field.
During the observership, not only was invited to ask questions (and doing so, provoked interesting discussions), but many of them shared their personal experience with me. They always point out difficult situations during surgery and stress exactly what to do and not to do.
The GAASS 2023 Fellows
I first started taking an interest in and researching the GAASS fellowship around 2021, after a friend of mine Dr. Lorenz Kuske was accepted and moved to Canada.
Dr. Kuske has just finished his GAASS fellowship in 2023 after 2 years. And while being humble, saying that it was very useful and he improved a lot, I later found out that he was outstanding and everyone was admiring his progress. He talked to me about what to expect and what I should do to maximize my time and how to learn the most during my 2-week observership. Throughout my GAASS observership, I had the pleasure of meeting and spending the majority of my time with 2 of the fellows - Dr. Thomas Siempis, and Dr. Sultan Aldrees.
Both of them were extremely welcoming and walked me through what I was about to experience. They sent me the surgical case previews for every surgical day and they were always there for any of my questions. I could tell they were quite busy. They had to do surgery, clinical patient examinations, and then prepare the surgical previews as well as clinical previews for the next day.
Despite being stressed and tired, they were always there for me. Always stopping for a second to point out the important things about the case and what to be careful about in the future. I was learning so much from these small discussions and was constantly taking notes!
My Schedule as a GAASS Observer
The observership took place mainly in the following places:
Credit Valley Hospital, Trillium Health Partners, Mississauga, Ontario
Prism Eye Institute - Mississauga/Oakville
Toronto Western Hospital
My day as a GAASS observer during the surgical days started at 7:30 am and typically ended by 5:00 pm. I noticed that the fellows were required to arrive even earlier and were making sure that the OR equipment is set up right. On clinic days, we started at 8:00 am and closed at 6:00 pm, and I was amazed by the non-stop flow of cases and patients throughout the day. Everything was smooth and efficient and quite well organized. Although days were packed and very busy, I felt I was having fun, learning, and really enjoying it!
One of the most impactful aspects of my time at the GAASS observership was the opportunity to observe advanced surgical techniques firsthand.
I witnessed complex surgeries, performed by great surgeons, including:
IOL repositioning
IOL exchanges
Scleral IOL fixation (Yamane IOL fixation)
Iris sutured IOL fixation
Iris defect repairs
Pupiloplasty
Trabeculectomies
Tube shunt implants
All kinds of MIGS, combined with cataract surgery, including the iStent infinite
Endocyclophotocoagulation of the ciliary body (ECP)
Observing the procedures gave me a new perspective on the latest advancements in glaucoma and anterior segment surgery.
The GAAS observership supervising mentor was constantly addressing questions to me and the fellows. I remember something he said: "You should never be here as a passive observer, you should always be aware of what is happening and be thinking what is the next step, what is the surgeon going to do, and how is he going to do it."
I could not say it better.
On one side, you can observe or assist with surgery and learn a bit. But only when you are actively putting yourself in the surgeon's shoes, thinking about what is yet to come, what could potentially go wrong, and what and when you must be extra careful about, you get the maximum benefit and learn the most.
In addition to all of those things about the GAASS observership, I was also struck by the warm and supportive environment. The mentors and fellows were always willing to answer my questions and share their insights and experiences with me. Their passion and dedication to patient care was inspiring and motivating. I was happy to meet the exceptional nursing staff of the GAASS team. Oh, wow are they great! I met Lisa, Jana, Richi, and Christine (forgive me for any spelling mistakes). And I believe they do not get enough credit for their amazing performance every day.
The level of surgical assisting of the scrub nurse was world-class! She was reading the mind of the surgeon and was always 2-3 steps ahead of him. The rotating nurse can have anything you want on the OR table in less than 10 seconds.
The atmosphere in the surgical room was very friendly, with a lot of jokes and an overall good mood. The whole team was actually not only helping patients but feeling great about it and doing it from their hearts.
My take-home message from the GAASS Observership
I made about 37 pages of notes and drawings that I plan to review and learn more about in the next few months.
I used Google Keep to quickly make notes on the go and then spent about 2-3 hours after I got home from the observership reviewing them, and reading more about each topic. I am sharing some of my "Quick notes" with you down below.
Needless to say, I learned a lot of new things about different ways to do an iris suture like McAhmed, McCannel, intraocular, and Seipser knot technique.
Overall, my GAASS observership was an incredible experience that allowed me to expand my knowledge and skills in ophthalmology.
I am grateful for the opportunity to have met such talented and dedicated mentors and fellows, and I look forward to applying the lessons I learned to my practice back home.
If you're an ophthalmologist looking to expand your knowledge and skills, I highly recommend the GAASS observership or GAASS fellowship program at the University of Toronto. The experience will be one that you will never forget. Guaranteed. Finally, I wish to express my gratitude to Daisy Huerto for her exceptional coordination of my observership program. Her efforts were truly commendable as she meticulously arranged for me to visit both the Prism Eye Clinic and the clinic at the Toronto Western Hospital, as well as Credit Valley Hospital enabling me to observe surgeries and clinical work. Throughout my stay, she was always there for all of my requests or inquiries that I had. Thank you, Daisy!
P.S. Feel free to enjoy all of the additional resources from GAASS that I gathered for all of you below.
Additional resources
Learn everything about the fellowship, the clinical duties, the surgical procedures, and research, as well as get information on the working schedule, evaluation, GAASS fellowship duration, and more.
We all know the Youtube channel of Dr. Ahmed where you may find various surgical tutorials, presentations, webinars, and deep discussions in the field of anterior segment and glaucoma surgery.
Dr. Devesh Varma's Youtube channel focuses on complex cases in ophthalmology, offering a a few, but very informative videos covering topics such Yamane Intrascleral Haptic Fixation, Nanophthalmic eye phaco techniques, IOL exchanges, Traumatic cataract with early CTR, iris repair.
The Matt Schlenker MD Youtube channel is an excellent resource for ophthalmologists seeking to stay informed about the latest developments and trends in the field of ophthalmology. With a focus on patient various MIGS and complex anterior segment surgeries, Dr. Schlenker's videos are short, informative, and straight to the point.
5. Dr. Ifran Kherani
There are two lectures by Dr. Kherani that you cannot miss on the following topics:
Follow the Instagram channel for complex cases and interesting stories from the GAASS Fellowship.
An Instagram profile, featuring interesting complex cases by Dr. Ike Ahmed.