In November 2017, two eye surgeons from a hospital in Beirut reported an intriguing case of visual loss in a colleague. A specialist in the retina, the colleague had suddenly developed a patch of blurry vision in one eye just a day or two after an intensely stressful day in the operating room. This was not the first time it had happened. The surgeon had experienced four such episodes in just a year, each preceded by a stressful day of operating.

The retinal surgeon was diagnosed with central serous chorioretinopathy (CSCR). A small amount of fluid had collected beneath a tiny region of the surgeon's retina, causing it to temporarily detach. The condition resolved after a few weeks, and a strict stress-management plan prevented another episode from happening again.

First described in 1866, CSCR has been tentatively linked to stress ever since World War Two, when several cases were reported in military personnel. Although subsequent research has associated CSCR with stress-related mechanistic pathways, it is often labelled “idiopathic” (arising from an unknown cause) if no trigger other than stress is found. Departing from convention, the surgeons labelled the condition “Operating Room CSCR” identifying stress as its cause.

Reflecting on what had made their colleague vulnerable to stress, the surgeons noted new surgical techniques made possible with better technology had stretched the physical limits of what a surgeon is able to do. While this progress had expanded the scope of surgery, operating at these limits placed immense mental strain on the surgeon.

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In 1959, management pundit Peter Drucker had predicted a dramatic transition in the nature of work would take place 50 years later. He coined a term for this new kind of work, “knowledge work” and anticipated the change would involve a move from physical to mental effort. He later wrote the centre of gravity of work would shift to “the man who puts to work what he has between his ears rather than the skill of his hands”.

The evolution of eye surgery has validated some of Drucker’s predictions. As technology improves, it transmutes the physical skill of the surgeon’s hands into the mental skills of analysis and concentration.