The Ophthalmology24 team is excited to share an interview with Dr. Ivo Ferreira, one of the leading educators in ophthalmology based in Mexico. Originally from Uruguay, Dr. Ferreira moved to Mexico City to pursue a clinical fellowship and is the founder of Oftalmo University and Phaco Mentors.
Oftalmo University was featured on The Ophthalmologist in 2024, Being recognized as one of the most impactful ophthalmic educational institutions in the world.
Watch the full video interview here:
Interview Transcript
Atanas Bogoev, MD: Hey everyone, my name is Atanas, and we're doing this interview on behalf of Ophthalmology24, where our mission is to help young ophthalmologists all across the globe by sharing awesome resources.
We have a special guest here, Dr. Ivo Ferreira. It's a pleasure having you here. He actually needs no introduction; he is one of the world's most famous educators when it comes to ophthalmology. And he's the founder of Oftalmo University, a very renowned institution. So Dr. Ferreira, it's nice having you here.
Dr. Ferreira: The pleasure is completely mine. Thank you for what you're doing, Atanas. I think you're doing a great job not only for Europe but for the entire world in giving people who want to improve as surgeons so much information.
Atanas Bogoev, MD: Thank you. So let's dive right in. Dr. Ferreira, could you actually talk about the start of your journey in ophthalmology and the challenges that you faced during your ophthalmology residency and training?
Dr. Ferreira: Sure. Well, I come from a small country in South America called Uruguay, where I did a very long med school. It was like eight and a half years, so imagine it was a long time, very difficult, a lot of resilience there.
For me, it was also very difficult to enter ophthalmology. Ophthalmology is very competitive, and since we are a small country, it's not easy to get in. Thank God I prepared myself and got into the program, but then the issue was the lack of surgical training. I thought of myself as unique in the world, the only person who had this disadvantage.
Then, with the years, I realized that this happens in many, many countries. So what happened for me was that I didn't have a chance in my country, so I started looking elsewhere and ended up in Mexico, where I did a two-year fellowship with no salary in which I could have a lot of surgical exposure. That's a little bit of my story.
Because of personal issues, I needed to stay in Mexico, and I did have the time to pursue this passion of mine, which was to be a mentor and a teacher. I think that big obstacle that I had in my life, if it wasn't for that, I would probably be in Uruguay doing surgery and seeing patients like everybody else.
Atanas Bogoev, MD: Yes, I mean, it's amazing how far away we are, and despite this, I can totally connect with you. I appreciate what you went through because I actually myself went through the same thing, and many ophthalmologists in Europe, Asia, and all across the globe are having difficulties with surgical training and are going through the same thing.
Talking about the clinical fellowship that you did in Mexico, could you tell us a bit more about it? Was it difficult to get in, and what was your surgical training like? What were the difficulties there, and how did you approach your learning?
Dr. Ferreira: Sure. Mexico has many different programs in which you can have surgical training. Mostly, you know, because medical training you can have everywhere, but a very structured surgical program is not easy, even in many parts of the world.
The first thing, to answer your question, it was very difficult to enter. I needed to come two or three times to present myself. I needed to do a surgical test in a simulator and also a theoretical test to prove my knowledge. For foreigners, the good thing is you don't need to do all the paperwork to do surgery. However, there is no salary. So imagine, and this is not easy for people to be able to spend even one or two years without a salary.
There are other programs like this in Mexico, I would say, like from the top of my head, it's like, let's say, between six to eight programs that you can have this. Again, it's a big investment, but if you are really motivated to become a surgeon, I think it's a great thing to do.
Atanas Bogoev, MD: Let's switch the tempo and talk about Oftalmo University a little bit. As we recently read in the Ophthalmologist magazine, you were actually recognized as one of the best, most impactful global institutions.
Could you talk a bit about the idea of founding Oftalmo University, launching it, and then going through the execution of the mission of teaching young ophthalmologists and surgeons, experienced surgeons, to enhance their training?
Dr. Ferreira: Sure. As I told you, after I finished my fellowship, I did 1,000 cases in one year. So imagine the volume; I did a big volume. Also, I was introduced to the surgical simulator with virtual reality called the EYESI.
After that, because of personal issues, I said, okay, now I have a chance to teach. So I started digging in, and the first thing we did was we founded Oftalmo University as a digital platform. We wanted to have an open platform in which we could see talent, see people who wanted to do different things, and give them a space to communicate.
We started being in meetings, we started being very well known for webinars, and then suddenly I said, okay, now it's time to have a physical campus, like a real campus. That started in 2020, and thank God, we started training people from all over the world.
People would talk to each other, and people would know the program, and people would come from many different places. You are one of the amazing colleagues that we had the chance to have here. You made a huge investment to come to train, to be open-minded, to train in a simulated environment, which is not an easy decision because many people say, I'm going to do surgery; the place to learn is the operating room.
I think you need to be very open-minded and see simulation as a big tool to invest in to come to a course like this. In this evolution, we started noticing that what we did was exponential because every person we trained would become a surgeon and start doing surgery while we were training other people.
So actually, we did the math, and last year, if you pick all the students we have, we did an average, but we did a study that our students, our colleagues, because we're part of a big family, are doing around between 1,200 and 1,600 cataracts per year. So imagine the impact we had.
At some point, we were contacted by the amazing magazine, the Ophthalmologist, and they said, guys, you really need to see how you are impacting in a very exponential way. When you train somebody, that person is going to spend 10, 20, 30, even more years doing surgery. So that's exponential.
What we really want with this impact and what we want with Of University is not to try to center everything we know in this physical space, but rather to grab this knowledge, package it up, and put it in different parts of the world so many people can use it.
Oftalmo University - Social Media:
Atanas Bogoev, MD: Fantastic. I totally agree. Improving even a small amount gives you an exponential advantage because of the vast scale of what you guys are doing. Being there on-site and being a mentor, supervising, and giving tips, looking at so many students, what would you say is the best method of training? Is it through dry lab, wet lab, simulation, or a combination of both?
Dr. Ferreira: That's an excellent question, and I think it's a question we are answering every single day, and actually, it's changing from day to day. What I really want with people is when they come to me, I would like them to put an objective, aim for it, and make it happen. Respect the process, but go for that objective. To do that, I'm trying to be always very realistic.
By this, I mean, in my opinion, the best way to learn something is in a simulated environment. Virtual reality brings a lot to the table because you can change scenarios, have objective feedback, practice the same task 50, 100, 200, 500 times, and understand why you do what you do, etc.
Then you have the wet lab scenario, in which you are using the machines, hearing the phaco machine, having the handpiece in your hand, having the second instrument in your hand, and pressing the foot pedals you are going to use in the simulator. So, in my opinion, the best place to learn is a simulated environment with virtual reality and a wet lab. But we cannot forget the entire journey of a human being becoming a surgeon.
Right now, we are completely obsessed with what happens afterward. So what we want now is what happens from training to the operating room. So what we're doing now is, okay, we know that the best place to learn is a simulated environment. You need to have a certain time with certain characteristics in which the elements are high-fidelity simulation, a methodology of how an adult learns, and a mentor.
I think the figure of the mentor is crucial. But now we are going to, okay, what happens afterward? What happens when you finish this course, and then you have one week until your first surgery in the operating room? I think there's a lot to train there, and let's be honest too, there is a journey in the operating room. Every single person who is out there, if they make the decision to become a surgeon, we can help them design this experience. You did an amazing article a couple of months ago about all these amazing opportunities that people have to go and do surgery on live patients.
I think that's great. You are going to need those numbers; you are going to need supervision in these first numbers. What I'm trying to say is, don't look at these things as detached from your journey. Let's design the entire journey for you. Let's understand the power of simulation and a simulated environment. Then let's prepare you for your first surgeries and design your first 20, 30, 40 cases in the operating room. So, it's a very complex answer, and I think every single day it's changing.
The good thing is people now have more opportunities than ever.
Atanas Bogoev, MD: I totally agree, completely agree with all your points. For me, one of the best things about a simulated environment is the ability to fail safely without harming the patient. From your experience, how important do you think it is for a student to tackle a difficult task many times and have the ability to fail safely?
Dr. Ferreira: There is a saying from Eric Ries, who is an entrepreneur that I really like, and I like to apply his saying: if you cannot fail, you cannot learn, period. We already know this; we know that human beings are connected in a way that failure is the master of everything. That's exactly what we want in a simulated environment, to make failure okay and part of your training without harm to another human being.
People open up, understand this, and learn in a completely new way. This is my most important message to all the young or old people who want to become surgeons. Now you have a chance, but you need to think differently, put an objective, understand the journey, and do part of your training in a simulated environment.
Atanas Bogoev, MD: Great, I completely agree. That's true for everything, right? Let's not only talk about cataract surgery; let's talk about retina or a new device. You're doing amazing things with glaucoma, right? Let's say I'm a cataract surgeon, and I want to learn to do MIGS.
What if we do it in a simulated environment? It's completely different from doing a wet lab in a meeting. Oh yeah, the MIGS, this is the lens, let's put it out there. No, that's great, that can give you some skill, but I'm talking about a real simulator environment. In MIGS, you are designing all the instruments, you have the microscope you're going to use in the operating room, the dialogues you're going to have with the people assisting you. You're going to ask for this instrument, for that instrument. If this goes right, if this goes wrong, let's simulate everything that could go wrong and what I can do next. The power of simulation is huge, not only for people in the beginning of their training but to become competent, excellent, and even masters.
Atanas Bogoev, MD: Yes, I think it definitely has a great advantage there. Regarding this, when I was in Oftalmo University, what struck me most is that you approach learning surgery not just as a simple task you need to finish in the simulator course. But you take surgery as this unique approach, the same way that elite athletes actually approach their sport. I know sports play a big role in your life. How would you say that? What do you find common between a surgeon and an elite athlete?
Dr. Ferreira: This is actually a very nice question related to the Olympics now. I'm so glad you mentioned the Olympics because I do believe that, as Olympians, we are very close to those kinds of athletes. I'm going to tell you why. You said we should treat ourselves as elite athletes. That's definitely a fact. Think about it.
We do something in which we need to succeed every single time, in which failure is not an option. You don't have the option to fail, and you need to excel every single time. I believe when you make the decision to become a surgeon, you're thinking about the technical skills, the manual skills, probably some people are talking about the decision making and the problem solving, but very few are really talking about what it means to be a surgeon.
What it means to have a complication and then five minutes later be talking to the patient or to some relative of the patient saying things didn't go well, or that Friday night that everybody's partying and drinking a beer but you had 18 cases, and 16 were great but two didn't go as well as you wanted. Now suddenly your brain is like... so we don't talk about those things.
That's exactly what we want here. We want that approach. We want to talk about the mindset component of becoming a surgeon. It's funny because, since I like to talk about athletes, many people were talking about this amazing speech that Roger Federer did in Dartmouth a couple of months ago. Amazing, yeah, amazing. He was saying, I was number one in the world, winning 52% of my points.
I was saying, okay, good. You can fail, you can lose some games, you can lose some sets, you can lose some... but we don't have that. So what happens with the mindset of somebody like an Olympian that trains four years for one shot? That's a completely different mindset, and it's something you really need to train. If we think as elite performers, this is the way of thinking we need to have.
We need to be in one way as performers, elite athletes, and create this moment to deliver the best we can. But in another way, we need to remember that we are human beings, and this is a role that we have, and we also need to try to disconnect from this. This is very complex; I don't want to get very deep, but I want people to have at least an idea of the way we approach surgery.
Atanas Bogoev, MD: Right, yes, it's a very nice overview. Okay, let's switch to your tips for young ophthalmologists. As someone who has navigated such a difficult path in your career and ended up being one of the best educators in the world, what advice would you give to young ophthalmologists who are just starting their journey and want to become great surgeons? What should they focus on?
Dr. Ferreira: Perfect. Again, I'm going to repeat myself a little bit, but the first thing, everything starts with a choice. Everything starts with really doing an introspective journey of making the decision to become a surgeon. This is not about seeing phaco and saying, oh, this is so good, this looks so great, and I want to do that.
No, this is much bigger than that. But after you make that decision, because I think you should, because it's an amazing career, it's an amazing thing to be a surgeon and a cataract surgeon and improve people's lives with your job. I think it's something incredible. But after you do that, it's as simple as this: put an objective, actually close your eyes and visualize yourself on that day that you're ready to do a case by yourself, to do 50 cases in one morning, to do a surgery on a relative or, you know, so many other things.
When you actually see that, then start looking for the process to make it happen. My advice to young people is they have amazing ways to do it now. It's much easier than in the past. In the past, it was difficult. I didn't have high-fidelity simulation as developers now, we didn't have so many mentors, and we didn't have the technology to do this kind of thing.
Imagine, I was talking about following people in the first cases we put. I don't have any commercial interest, but with many of our students, what we put is a device, in this case, called Microsurgical Trainer in the microscope, and suddenly I'm giving you real-time feedback watching your surgery no matter where you are in the world. This is huge.
This is exactly what you guys, young people, need to do. You need to leverage technology for your favor. What I strongly recommend is make the decision, put the objective clear in your mind, and let's design that process. If you cannot design that process, we can help you.
This doesn't mean that you need to train with us. Let's say you are from Poland, and there is no way you can do surgery. Let's find you a very important course, a simulated course with a good mentor. Remember, the other concept is to try to find a mentor. It's the most difficult thing to do, but the moment you find a mentor, everything becomes easy. Mentorship is not easy and can also be leveraged through technology. Probably the mentor doesn't have time for you, but with technology, you can even pick a mentor and pick his brain. Let's put an example, pick the brain of Ike Ahmed.
Go to YouTube, as simple as that. Go to YouTube and watch everything he does. It's already there; it's already published. You just need to take your time and watch it. Exactly. We didn't have that 10 years ago. You couldn't pick the brain of a genius like that 10 years ago.
That's exactly what I'm trying to say to people. My obsession, my personal obsession, is to help people design that kind of journey. Is that person from Poland? Connect them to a simulated course and help them from simulation to the operating room. When they're in the operating room, try to give them the most important thing that a mentor can give you: guidance, feedback, feedback, feedback. You need feedback to improve.
I think we are living in exciting times. Atanas, what you're doing is great, and please keep doing it because we need many people like you to connect young people who have dreams and who are very determined and have this passion for becoming a surgeon. Sometimes it doesn't look easy.
Atanas Bogoev, MD: Fantastic. I'm all for leveraging technology to enhance your skills, and we are happy enough to live in times where we have so much information available. Actually, you need to prioritize where you learn from. Speaking of this, you obviously have a lot of resources at Oftalmo University, a lot of courses online. Would there be any specific courses that you recommend for young ophthalmologists that would greatly impact their career? Feel free to recommend any other books or courses.
Dr. Ferreira: Sure, there are many, and many people know them. There is, for example, such great work done by two or three surgeons in India who are putting out so much amazing content. From the US, Uday Devgan, I know everybody knows him because of the amount of content that we have there. So much you can learn. There are many other resources.
There are people who love surgery, they love cameras, they love images, and they do videos. For example, Dr. Parsa from Russia, you see this guy with such great quality and doing very things and passionate, he's very passionate about communicating with no business model behind it, which I love. I would recommend that kind of content.
But I believe that content mostly gives you cognitive knowledge, meaning recognizing patterns and making decisions. What we have been doing, and we have been doing it in English to reach everybody, we have been doing it in our own unique way with a different perspective because we want to give you the entire perspective.
For example, one of the things we like is to put three cameras in the surgery so you can see what happens in the hands, what happens in the incision, what happens outside the eye. Another thing we do with our mentors is leverage virtual reality.
We put the virtual reality video to help you understand decision making, solve complications, and talk about the mindset when complications happen. I'm a little biased here, but I would strongly recommend our platform as a different perspective on phaco mentors.
Atanas Bogoev, MD: Perfect. I would totally recommend it too. There are so many webinars and resources. We'll post on social media so you guys can follow them and keep you in the loop. I know that you're very interested in philosophy and self-improvement. Maybe this is the time to ask you, could you recommend any books outside of medicine, outside of ophthalmology, that could help surgeons develop this winner mindset, this mentality of improving constantly and getting better?
Dr. Ferreira: You already know me on this one. I have so many ideas. I'm going to try to make it short. I'm going to do something because of you, because I think what you do is great. I have many books that I love, and there are a couple of books that I'm like, you know what, I'm not going to even recommend this kind of book because they're so good that I'm going to keep it. I'm going to do the opposite only for you. If somebody is behind this dream of becoming a surgeon, I think they need to start with the book called "Mastery" by Robert Greene.
"Mastery" is a book that is going to tell you exactly that, how you can go from a dream and an objective to real mastery in any discipline. I think that applies to surgery. I strongly recommend "Mastery" because of what surgery means.
I also strongly recommend a book called "Principles" by Ray Dalio, which is completely amazing.
Also, to be grateful and to be simplistic in a good way, I'm going to recommend another book from Mexico, which we are very grateful for this country allowing me to become a surgeon and have our campus. It's called "The Four Agreements." It talks about four agreements that I think are extremely powerful.
With those three books, I think I've done an interesting job there.
Atanas Bogoev, MD: Thank you, that's very insightful. I appreciate it. Let's talk about your vision of the future. Obviously, simulation surgery, especially the VR simulators, have advanced beyond any expectations. They are really another exponential technology that we should definitely leverage. I remember myself, the journey, so I practiced on the simulator for the first time like five years ago, and the software and hardware have just improved tremendously. You being more in the game, where do you see this going? How has this improvement been over the years, and where do you see the technology going?
Dr. Ferreira: Well, this is secondary to a discussion with another great friend called Cristóbal Rodríguez from the US. He came to visit me, and we were in an open discussion, and he did something to me; he basically ruined me in a good way.
He said, Evo, you're making a mistake. You're thinking about today and what's going to happen in the future. Let's do something different, and that's exactly what I want to do with you, Atanas. Let's think about the future and then come back to where we are. Why not think about a moment, call it 10 years, 15 years, 30 years, I don't care, in which you can be 100% trained virtually? Think about it. Can it be possible? Of course, you can.
You're going to have the machines and the instruments, but then you're going to have a VR and an Apple Vision Pro, very advanced, where you're going to enter the operating room, and that's going to be the patient. Then you're going to perform surgery 100% virtually with high fidelity. I think, I hope, I can live until that day. I think we're far away from it, but I think we're going to reach a moment like that.
What I think is exactly what you say, that we're going to take huge leaps progressively to have machines that give you high fidelity for training. That's what I see in the future. I see fidelity going up, especially with virtual reality, because it's much easier to improve. I think we're going to improve the quality of artificial eyes. I believe that the simulated environment is going to be every single day even more important than the day before.
Atanas Bogoev, MD: Fantastic. I completely agree with your point, and we are seeing this before our eyes with the new software developments that are coming constantly. I want to finish this awesome interview with a very interesting question. I heard that something interesting is coming up in Europe that is going to revolutionize surgical training. Could you give us a small insight on that one?
Dr. Ferreira: Well, I have been so lucky because of what I do. It was very difficult for me to become a surgeon, and I see every single week people with that dream, and I think I can give them a lot of value. Then I had the chance to travel to other places, and we realized that this is something that happens almost everywhere. Actually, there are few countries that train people with big volumes.
One of the things that happened is we saw that in Europe, we saw people who are so smart, so motivated, and so ambitious in a good way. They want to become surgeons, they want to become good, they dedicated their lives to becoming doctors and ophthalmologists, so why not become cataract surgeons? As you probably know and everybody knows, cataract surgery is only rising.
Every single year, we need to do more surgery, and there is much research showing that the number of surgeries is increasing with new people coming. When we saw that, we wanted to do something in Europe. I think there are many great things coming in Europe.
The first thing is what the ESCRS leadership is doing. The ESCRS leadership now is very strong in saying we're going to do something about it. You have been part of that in Germany with the moving simulator and training people all over Europe. What we want is to add some value to that and to put an excellent center there with great mentors.
Think about a mentor, think about a surgeon who is actually making the conscious choice to be with you and train you instead of doing surgery on patients. This is not easy. That's exactly what we want to bring to Europe. We want to bring an excellent center where you can learn as much as you can in a simulated environment and prepare you for what comes next. Hopefully, very soon we're going to have a center like that in Europe.
Atanas Bogoev, MD: We're definitely excited to hear more about it, and we're going to follow you on social media for more info. Well, it's been a great pleasure, Dr. Ferreira. I love talking to you; it inspires me, and we can really see your passion. You're doing this from your heart, you're enjoying it, and this gives it another angle. It just makes you feel good, and you make the world a better place. Thank you for what you're doing, and thank you for this interview.
Dr. Ferreira: Oh, thank you, Atanas. You inspire me. You inspire me by communicating this, and I think all the colleagues have the chance to be so impactful for other people. This is something we really need to enjoy, and we really need to behave as a community and help each other and raise the game for all of us.
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Interview by Atanas Bogoev, MD