My Pre-Surgical Routine as an Eye Surgeon

As an ophthalmology consultant specializing in glaucoma and anterior segment surgery, my work often involves performing intricate procedures where precision, consistency, and preparation are paramount. While every case is unique, I’ve developed a pre-surgical routine.

That routine helps me remain focused, calm, and ready to deliver the best possible care. Here’s a behind-the-scenes look at what my day looks like before I scrub in.

1. The Night Before: Mental Framing and Case Review

Preparation begins well before I step into the operating room.

The night before surgery, I review the surgical list and go through the key details of each patient. I check previous operative notes and any relevant systemic history. That's especially important in glaucoma and oculoplastic patients, where comorbidities can influence surgical planning.

For complex cases like trabeculectomy, angle-based MIGS, or complex eyelid reconstructions, I mentally rehearse going through the surgical steps. Visualization and mental rehearsal have become essential tools in my surgical workflow. Sometimes I watch several videos on other ophthalmic surgeons to get fresh ideas and see how they are tackling similar cases.

2. Gameday: No Breakfast, No Coffee, No Sugar

I don't wake up early on surgical days. Usually around 7 AM. Many surgeons get up at 4 AM and proceed with a special morning routine. What is recommended: Wake up early and have a quiet morning. Avoid screens and instead prefer a few quiet moments over coffee or tea, which allows you to collect your thoughts.

A light, protein-rich, slow-carb breakfast is recommended to get you through long cases.

3. Arrival at the Hospital: Team Briefing

I like to arrive at the hospital just in time for the team briefing. Every morning, our whole physician team discusses the daily surgical plan and talks about challenges or details.

*The names, DOB, Insurance, and surgery procedures in the table above are not real.

I always try to be in the OR before my patient and the anesthesia team arrive.

This gives me time for:

• Checking the surgical microscope and phaco/MIGS equipment setup

• Confirming IOL power and devices for each patient (I recheck it before I start the case)

• Discussing any last-minute notes with the Anesthesia or nursing staff

For glaucoma procedures, whether it’s a MIGS, MIBS, Diode, or a Trabeculectomy, we have a very experienced nursing team that double-checks that all materials (mitomycin, viscoelastic, pre-loaded implants) are ready. I look at the surgical table before I start and ask for additional materials if I need anything specific for the case.

Small delays in preparation can interrupt surgery flow and increase stress once scrubbed in.

4. Camera On: Recording for Reflection and Teaching

Before scrubbing in, I take a moment to set up the surgical video recording system. A habit integral to my practice. I record nearly every case. Not just for documentation but also for teaching, reviewing techniques, and sharing insights with colleagues or trainees.

Some of my most valuable refinements as a surgeon have come from re-watching footage and pausing to ask:

• Could this step have been better?

• Why am I doing this twice?

• Was there another way to handle that complication?

  
  

The videos are also a fantastic resource for training sessions.

When mentoring junior colleagues, showing real, unedited cases with commentary makes the learning far more tangible than a textbook ever could.

"Every recording is helping me see what worked, what didn't and where I can improve."

5. Scrubbing In: Focus Mode

Scrubbing in is definitely a mental switch for me.

As I disinfect my hands, I mentally go through the surgical steps and remind myself to be present and focus on the moment. I say to myself that I am grateful I have the privilege to do what I do.

If we are having a case where a resident or another specialist is assisting me, I make sure they are concentrated on the case as well and are not worrying about what they have to do later in their day.

Next, I take a few moments before the case to outline the surgical goals and teaching points. I ask them to imagine they are doing the surgery and walk me through the surgical steps one at a time. Clarity beforehand allows smoother interaction once we're operating.

6. Team Time-out: The Power of Presence

Our surgical time-out isn’t just a formality. I make sure it’s intentional.

Everyone—anesthesiologist, nurse, scrub tech, assistant—should actually be listening.

I once observed Dr. Ike Ahmed at GASS. During the time-out, he was very quiet and although he was taking a time-out and going through the case, noone was listening. Dr. Ahmed stood up, raised his voice, and said: “Okay, everyone, let’s all pause—this patient is trusting us with their vision. Let’s do this right. He proceeded to do the time-out the right way.” This was a great learning experience for the fellow and for me. It just stuck with me. The tone you set as surgeon affects the whole room.

RELATED: GAASS Observership: What I Learned

5. During the Surgical Day: Flow and Flexibility

My rhythm in the OR is grounded in muscle memory and team coordination.

Each nurse knows my preferences—from the positioning of instruments to the exact phrasing I use when asking for a specific surgical instrument. But no surgery ever goes exactly the same way.

In glaucoma surgery, especially with complex angles or revision cases, I maintain flexibility and adaptability. Preoperative planning is important, but intraoperative judgment is critical.

Talk to your nurses and educate them on what you need and when. You shouldn't expect them to passively know what you are thinking. Spending a couple of minutes after the case to review or explain why you do things in a certain way can optimise the flow for the next case.

6. Post-Op: Documentation and Debrief

After the last case, I document thoroughly and write notes while the details are fresh.

I make sure to add important details to my surgical notes, and I always describe in detail if I had any difficulties or complications during surgery.

After leaving work, on my way home, I often go through a mental reflection:

• What went well today?

• Where could I improve?

• Did I teach effectively?

Some might say this has nothing to do with a pre-operative routine—but I see it as the final step in the cycle. Wrapping up the day with a clear head helps me leave work at work. I don’t want to be thinking about notes late in the evening or first thing the next morning. That sense of closure brings peace, and peace is what helps us come back tomorrow ready to do things even better—with a calm, focused mind.

Final Thoughts

Surgical days can be stressful, but also very rewarding. Make sure to develop your own pre-operative routine (feel free to use mine as a framework). It is our mission to do our surgeries as close to perfect as possible. Every patient we are operating on is a real person, trusting us with their vision. Trust is what shapes every part of my preparation. I'd love to learn from you too — comment below and share the best practices from your pre-op routine.