Physiological Stress In Cataract Surgery: A Scoping Study Using Heart-Rate Monitoring

To evaluate physiological stress responses in ophthalmologists during cataract surgery using heart‑rate monitoring, identify key stressors, and propose strategies to mitigate intraoperative stress.

Ophthalmologists at varying training levels were recruited from a single UK hospital, and heart rate recordings were collected over a period of 6 months in 2023.

Heart rate was recorded using a Polar H10 chest strap during cataract surgery and compared with each surgeon’s resting baseline obtained during a two‑hour out‑of‑hours period. Case complexity was graded using pre-defined patient and cataract factors. Heart‑rate changes were analysed with respect to role (operating vs. supervising) and surgeon seniority.

All surgeons demonstrated increased average heart rate during cataract surgery compared with baseline, with rises up to 40%. Maximal heart‑rate increases were smaller and varied by seniority: consultants exhibited the greatest rise, fellows the least, and trainees intermediate. Consultants also displayed higher heart rates when operating than supervising. Patient‑related factors—such as communication barriers, co-morbidity, or behavioural unpredictability—appeared to induce stress more strongly than cataract‑related anatomical factors.

Cataract surgery induces measurable physiological stress in ophthalmologists, particularly in cases involving complex patient factors. Scheduling these cases earlier in the day, distributing demanding cases more evenly across the surgical team, and simple environmental modifications such as theatre music may help reduce stress. This is important not only for preserving surgeon well-being but also for sustaining surgical performance, maintaining patient safety, and supporting long-term workforce resilience. Larger studies incorporating heart-rate variability are warranted to further characterise intraoperative stress and inform workforce wellbeing strategies.