Microsurgeries performed on eyeballs, though small in nature, have a large and often life-changing impact on patients. Nicholas Tan, MD, a resident at the University of Colorado Anschutz Department of Ophthalmology, witnessed this firsthand in 2019 when his father received cataract surgery combined with an Ahmed glaucoma valve, a type of drainage device placed within the eye to reduce intraocular pressure.
Inspired to help others in a similar way, Tan later shadowed his father’s surgeon, Nathan Radcliffe, MD, in New York, and as he puts it, “the rest is history.” Now a rising fourth-year resident and the future education chief of his class at CU Anschutz, Tan is training to become the same type of skilled ophthalmologist who helped his father.
Learning to operate on an eyeball, one of the most complex organs in the body, is challenging and complex — but a key feature at the Sue Anschutz-Rodgers Eye Center has helped Tan hone his skills: the wet lab.
Open to CU Anschutz ophthalmology trainees and faculty, the department’s wet lab is equipped with state-of-the-art machines, systems, and tools to practice surgical skills and develop exceptional techniques so that when the time comes, the ophthalmologists will approach the operation room with confidence.
“Practice in the wet lab helped everything flow more smoothly on surgical days, whether the task was strabismus surgery, cataracts, corneal suturing, or tube shunts,” Tan says. “Time there at the wet lab also imparts confidence that I’ve done my absolute best to keep patients safe.”
Witnessing the growth of residents is a highlight for Deidre St. Peter, MD, an assistant professor of ophthalmology who specializes in glaucoma, a progressive condition that causes damage to the optic nerve — the cord connecting the brain and the eyes — often due to increased intraocular pressure.
“It takes a lot of practice to feel comfortable with performing a microsurgery, and there are a lot of new surgical techniques and devices in ophthalmology, so the ability to teach and practice our surgical skills is critical,” says St. Peter, who is the resident wet lab and surgical curriculum director. “That’s why the lab is so important.”
During their four years of training at CU Anschutz, ophthalmology residents are exposed to a variety of eye conditions in different patient populations across multiple clinical settings, including the Sue Anschutz-Rodgers Eye Center, Rocky Mountain Regional Veterans Affairs Medical Center, Children’s Hospital Colorado, and Denver Health.
Given the many cases they see, the residents also observe a breadth of different surgeries. For instance, surgeries for glaucoma patients include laser procedures, minimally invasive glaucoma surgery (involves making smaller cuts and using specialized tools), tube shunt surgery (places a drainage device in the eye to lower pressure), and trabeculectomies (creates a new pathway for fluid in the eye to drain).
Residents also observe and practice surgeries to remove cataracts, a common condition where the lens of the eye becomes cloudy. Other surgeries may involve correcting eye vision issues (also known as refractive eye surgery) or intervening in emergency situations, such as if an accident causes damage to the cornea (the eye’s outermost layer) and sutures are needed.
To ensure residents are well prepared to address the versatile needs of patients, the trainees regularly receive surgical training in the wet lab and have protected time each week to practice their skills.
“Each ophthalmology subspecialty has their own area in the wet lab, whether it be intraocular surgery on the retina or oculoplastic surgery that focuses on the eyelid and orbital structures around the eye,” St. Peter says. “Essentially, you can practice almost any surgical procedure here. Laser, intraocular, extraocular — you can do it all.”
Among the useful tools in the wet lab are simulated eyes. Some of these synthetic eyes are filled with a jelly-like substance to imitate a real eyeball and allow residents to get hands-on practice with procedures such as cataract extraction or using lasers. Residents can also access machines like the CENTURION Vision System, a machine popular in ophthalmology practices across the country to help with removing cataracts.
Representatives of different manufacturers in the ophthalmology industry occasionally visit the wet lab to help train residents on how to use their devices. For example, representatives of the company AbbVie have visited the wet lab to demonstrate how to use the company’s XEN Gel Stent, a small tube-like structure that is placed in the eye to reduce intraocular pressure for patients with glaucoma.
“The night before I did my first XEN implant, they worked with me in the wet lab. That was so helpful, as it gave me more practice and confidence before the surgery,” says St. Peter, who completed her fellowship training at CU Anschutz.
As a glaucoma specialist, St. Peter was excited to work with Tan, who she knew also had an interest in glaucoma, and help him develop his surgical skills.
“When he first started, he was really excited to start surgically but also nervous,” St. Peter says. “He spent the most time out of any resident in the wet lab, and he has grown so much surgically. I remember I was so comfortable operating with him at Denver Health because I knew how much time and energy he put into preparing.”
Tan was drawn to the residency program at CU Anschutz because, as he says, it “checked all the boxes: high surgical volume, all subspecialties represented in a four-hospital system, balance between resident-run and attending clinics, and a culture that encourages inquiry.”
His training, so far, has been rigorous and fulfilling. The wet lab has helped Tan practice different surgeries and important techniques. In microsurgeries, every factor matters — including the hand position of the surgeon.
“I’ve recently used the wet lab to workshop cataract surgery hand positions,” Tan says. “The ideal grip varies by step and surgeon.”
For example, when it came to performing the surgical technique called capsulorhexis, which involves creating a circular opening in the eye to access a cataract, Tan initially found it challenging making pivots in the incision.
“In the lab, I realized that my grip relied too much on wrist movements to twirl the forceps, and in turn caused me to bump against the sides of the wound,” he says. “By instead prioritizing finger motion, especially in the subincisional area, my rhexis step became much more efficient.”
In addition to his hard work, Tan credits his growth to the mentorship of ophthalmologists like St. Peter, who he describes as authentic, attentive, and generous.
“Her mentorship has been a difference-maker in several ways, but what stands out most is how she taught me to be kinder to myself as a surgeon,” he says. “She’s the person who calls you after a tough case to ensure you’re doing okay. I credit her for helping me build a more sustainable outlook on the craft.”
Tan aims to become a glaucoma and advanced anterior segment surgeon who can offer the full spectrum of glaucoma interventions, advanced intraocular lens (IOL) technologies, secondary IOLs, and certain refractive solutions. He also plans to continue his research into emerging glaucoma therapeutics. St. Peter has no doubt he will succeed in his goals.
“Dr. Tan is a great surgeon, and I know he’s going to do wonderfully,” St. Peter says.
Committed to always improving, the ophthalmology residency program implemented a new surgical curriculum during the 2025-26 academic year. Each second-year resident, of which there are six in total, was paired up with a surgical mentor who practiced with them throughout the year.
Together, the mentor-mentee pair visited the wet lab to practice surgical procedures. Residents also could record themselves performing procedures independently in the wet lab and send those recordings to their mentor for feedback.
“Our goal was to get residents into the operating room with their surgical mentor for one cataract surgery before the end of the year. The mentors will then follow the residents throughout the rest of their residency training,” says St. Peter, who serves as a mentor to resident Matthew Lam, MD.
“The change has been great, and we’ve received positive feedback from residents, because it helps ensure residents are not accidentally building bad surgical habits,” she adds. “It’s wonderful to have that one-on-one feedback.”
In addition to the wet lab, the residency program offers trainees access to an EYESI Surgical Simulator, a virtual reality simulator that provides real-time feedback as users practice surgeries like cataract removal.
“What we offer here are resources I would’ve liked to have when I was a resident,” St. Peter says. “Our residency program really pays attention to resident feedback and making changes appropriately. And residents like Dr. Tan have been helpful liaisons, voicing what the residents need.
“Overall, I think the wet lab is helpful for residents’ wellbeing, as it helps make sure they are connected to mentors and given the time and resources needed to do their best work,” she adds. “I’m really proud that we have all these resources available.”