{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T06:21:21Z","timestamp":1783405281722,"version":"3.54.6"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Health Sciences"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Graefes Arch Clin Exp Ophthalmol"],"published-print":{"date-parts":[[2026,7]]},"DOI":"10.1007\/s00417-026-07189-1","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T08:25:33Z","timestamp":1773044733000},"page":"2225-2233","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["From incision to implantation: holter-based stress profiling in ophthalmology residents during cataract surgery"],"prefix":"10.1007","volume":"264","author":[{"given":"Kemal","family":"Tekin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kubra Ozdemir","family":"Yalcinsoy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elcin Ozdemir","family":"Tutan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayberk","family":"Bilir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Murat","family":"Uzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merve Inanc","family":"Tekin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"7189_CR1","doi-asserted-by":"publisher","first-page":"954","DOI":"10.1016\/j.ophtha.2010.08.047","volume":"118","author":"AS Woodfield","year":"2011","unstructured":"Woodfield AS, Gower EW, Cassard SD, Ramanthan S (2011) Intraoperative phacoemulsification rates of second- and third-year ophthalmology residents a 5-year comparison. Ophthalmology 118:954\u2013958","journal-title":"Ophthalmology"},{"key":"7189_CR2","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1016\/j.survophthal.2017.09.006","volume":"63","author":"K Kaplowitz","year":"2018","unstructured":"Kaplowitz K, Yazdaine M, Abazari A (2018) A review of teaching methods and outcomes of resident phacoemulsification. Surv Ophthalmol 63:257\u2013267","journal-title":"Surv Ophthalmol"},{"key":"7189_CR3","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1016\/j.ophtha.2006.03.026","volume":"113","author":"G Binenbaum","year":"2006","unstructured":"Binenbaum G, Volpe NJ (2006) Ophthalmology resident surgical competency: a national survey. Ophthalmology 113:1237\u20131244","journal-title":"Ophthalmology"},{"key":"7189_CR4","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.sjopt.2018.11.009","volume":"33","author":"AM Alfawaz","year":"2019","unstructured":"Alfawaz AM (2019) Ophthalmology resident surgical training: can we do better? Saudi J Ophthalmol 33:159\u2013162","journal-title":"Saudi J Ophthalmol"},{"key":"7189_CR5","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1001\/jamasurg.2024.6072","volume":"160","author":"J Awtry","year":"2025","unstructured":"Awtry J, Skinner S, Polazzi S, Lifante JC, Dey T, Duclus A, TopSurgeons Study Group (2025) Association between surgeon stress and surgical complications. JAMA Surg 160:332\u2013340","journal-title":"JAMA Surg"},{"key":"7189_CR6","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/j.amjsurg.2007.08.059","volume":"196","author":"V LeBlanc","year":"2008","unstructured":"LeBlanc V, Woodrow SI, Sidhu R, Dubrowski A (2008) Examination stress leads to improvements on fundamental technical skills for surgery. Am J Surg 196:114\u2013119","journal-title":"Am J Surg"},{"key":"7189_CR7","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1136\/bmj.320.7237.781","volume":"320","author":"RL Helmreich","year":"2000","unstructured":"Helmreich RL (2000) On error management: lessons from aviation. BMJ 320:781\u2013785","journal-title":"BMJ"},{"key":"7189_CR8","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/j.amjsurg.2018.02.017","volume":"216","author":"KL Chrouser","year":"2018","unstructured":"Chrouser KL, Xu J, Hallbeck S, Weinger MB, Partin MR (2018) The influence of stress responses on surgical performance and outcomes: literature review and the development of the surgical stress effects (SSE) framework. Am J Surg 216:573\u2013584","journal-title":"Am J Surg"},{"key":"7189_CR9","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1007\/s00464-024-11389-3","volume":"39","author":"A Tam","year":"2025","unstructured":"Tam A, Bateman S, Buckingham G, Wilson M, Melendez-Torres GJ, Vine S et al (2025) The effects of stress on surgical performance: a systematic review. Surg Endosc 39:77\u201398","journal-title":"Surg Endosc"},{"key":"7189_CR10","doi-asserted-by":"publisher","first-page":"1354","DOI":"10.1038\/s41433-019-0423-1","volume":"33","author":"SW Tung","year":"2019","unstructured":"Tung SW, Watts P, Kwun-Hong Ho D, Williams GS (2019) How stressful is cataract surgery for consultants and ophthalmic trainees? Phacoemulsification is a stressful experience for young consultants. Eye (Lond) 33:1354\u20131355","journal-title":"Eye (Lond)"},{"key":"7189_CR11","doi-asserted-by":"publisher","first-page":"1640","DOI":"10.1177\/11206721231154611","volume":"33","author":"AS Ansari","year":"2023","unstructured":"Ansari AS, Tung ASW, Wright DM, Watts P, Williams GS (2023) Stress and cataract surgery: a nationwide study evaluating surgeon burnout. Eur J Ophthalmol 33:1640\u20131649","journal-title":"Eur J Ophthalmol"},{"key":"7189_CR12","doi-asserted-by":"publisher","first-page":"500","DOI":"10.2486\/indhealth.2017-0190","volume":"56","author":"S Jarvelin-Pasanen","year":"2018","unstructured":"Jarvelin-Pasanen S, Sinikallio S, Tarvainen MP (2018) Heart rate variability and occupational stress-systematic review. Ind Health 56:500\u2013511","journal-title":"Ind Health"},{"key":"7189_CR13","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1007\/s00420-020-01525-6","volume":"93","author":"T Anne-Fleur","year":"2020","unstructured":"Anne-Fleur T, Reijmerink I, van der Laan M, Cnossen F (2020) Heart rate variability as a measure of mental stress in surgery: a systematic review. Int Arch Occup Environ Health 93:805\u2013821","journal-title":"Int Arch Occup Environ Health"},{"key":"7189_CR14","first-page":"577","volume":"141","author":"B Thielmann","year":"2016","unstructured":"Thielmann B, Boeckelmann I (2016) Heart rate variability as an indicator of mental stress in surgeons - a review of the literature. Zentralbl Chir 141:577\u2013582","journal-title":"Zentralbl Chir"},{"key":"7189_CR15","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/j.surg.2009.10.007","volume":"147","author":"S Arora","year":"2010","unstructured":"Arora S, Sevdalis N, Nestel D, Watts P, Williams GS (2010) The impact of stress on surgical performance: a systematic review of the literature. Surgery 147:318\u2013330","journal-title":"Surgery"},{"key":"7189_CR16","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1016\/j.jamcollsurg.2005.05.004","volume":"201","author":"AP Tendulkar","year":"2005","unstructured":"Tendulkar AP, Victorino GP, Chong TJ, Bullard MK, Liu TH, Harken AH (2005) Quantification of surgical resident stress on call. J Am Coll Surg 201:560\u2013564","journal-title":"J Am Coll Surg"},{"key":"7189_CR17","doi-asserted-by":"publisher","first-page":"1554","DOI":"10.1002\/bjs.5544","volume":"93","author":"I Hassan","year":"2006","unstructured":"Hassan I, Weyers P, Maschuw K, Dick B, Gerdes B, Rothmund M, Zielke A (2006) Negative stress-coping strategies among novices in surgery correlate with poor virtual laparoscopic performance. Br J Surg 93:1554\u20131559","journal-title":"Br J Surg"},{"key":"7189_CR18","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/j.amjsurg.2017.05.015","volume":"216","author":"M Weenk","year":"2018","unstructured":"Weenk M, Alken APB, Engelen LJLP, Bredie SJH, van de Belt TH, van Goor H (2018) Stress measurement in surgeons and residents using a smart patch. Am J Surg 216:361\u2013368","journal-title":"Am J Surg"},{"key":"7189_CR19","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2017.00258","volume":"5","author":"F Shaffer","year":"2017","unstructured":"Shaffer F, Ginsberg JP (2017) An overview of heart rate variability metrics and norms. Front Public Health 5:258","journal-title":"Front Public Health"},{"key":"7189_CR20","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1093\/oxfordjournals.eurheartj.a014868","volume":"17","author":"Task Force of the European Society of Cardiology and The North American Society of Pacing and Electrophysiology","year":"1996","unstructured":"Task Force of the European Society of Cardiology and The North American Society of Pacing and Electrophysiology (1996) Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Eur Heart J 17:354\u2013381","journal-title":"Eur Heart J"},{"key":"7189_CR21","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.sjopt.2011.10.007","volume":"26","author":"M Mohammadpour","year":"2012","unstructured":"Mohammadpour M, Erfanian R, Karimi N (2012) Capsulorhexis: pearls and pitfalls. Saudi J Ophthalmol 26:33\u201340","journal-title":"Saudi J Ophthalmol"},{"key":"7189_CR22","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1016\/S0886-3350(13)80340-9","volume":"19","author":"S Masket","year":"1993","unstructured":"Masket S (1993) Postoperative complications of capsulorhexis. J Cataract Refract Surg 19:721\u2013724","journal-title":"J Cataract Refract Surg"},{"key":"7189_CR23","doi-asserted-by":"publisher","first-page":"2282","DOI":"10.4103\/ijo.IJO_3517_20","volume":"69","author":"J Kaushik","year":"2021","unstructured":"Kaushik J, Pannu A, Chaitanya YVK, Kumar A, Singh Parihar JK, Jain VK (2021) Effect of complicated ocular surgery on stress-related parameters: a novel outlook into surgeon\u2019s health. Indian J Ophthalmol 69:2282\u20132286","journal-title":"Indian J Ophthalmol"},{"key":"7189_CR24","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1097\/j.jcrs.0000000000000798","volume":"48","author":"V Cap","year":"2022","unstructured":"Cap V, Palkovits S, Bijak M, Ruiss M, Schmoll M, Findl O (2022) New approach to quantifying acute stress in cataract surgeons to investigate the relationship between surgeon experience and intraoperative stress. J Cataract Refract Surg 48:549\u2013554","journal-title":"J Cataract Refract Surg"},{"key":"7189_CR25","doi-asserted-by":"publisher","first-page":"3535","DOI":"10.2147\/OPTH.S266501","volume":"14","author":"T Chandra","year":"2020","unstructured":"Chandra T, Khan P, Khan L (2020) Study to evaluate stress among ophthalmic surgeons with different levels of surgical experience. Clin Ophthalmol 14:3535\u20133540","journal-title":"Clin Ophthalmol"},{"key":"7189_CR26","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1002\/cne.920180503","volume":"18","author":"RM Yerkes","year":"1908","unstructured":"Yerkes RM, Dodson JD (1908) The relation of strength of stimulus to rapidity of habit-formation. J Comp Neurol Psychol 18:459\u2013482","journal-title":"J Comp Neurol Psychol"},{"key":"7189_CR27","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1007\/s00268-011-1316-z","volume":"36","author":"AM Ali","year":"2012","unstructured":"Ali AM (2012) The role of stress in optimizing surgical performance. World J Surg 36:480","journal-title":"World J Surg"},{"key":"7189_CR28","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-56501-8","volume":"14","author":"A Yamamoto","year":"2024","unstructured":"Yamamoto A, Miyata M, Tsujikawa A (2024) Ophthalmologists\u2019 assessment of the handling characteristics of the novel Finesse Reflex Handle in comparison to those of a conventional handle. Sci Rep 14:5736","journal-title":"Sci Rep"},{"key":"7189_CR29","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1016\/j.jcrs.2006.01.045","volume":"32","author":"IJ Dooley","year":"2006","unstructured":"Dooley IJ, O\u2019Brien PD (2006) Subjective difficulty of each stage of phacoemulsification cataract surgery performed by basic surgical trainees. J Cataract Refract Surg 32:604\u2013608","journal-title":"J Cataract Refract Surg"},{"key":"7189_CR30","doi-asserted-by":"publisher","first-page":"284","DOI":"10.3129\/i09-051","volume":"44","author":"G Prakash","year":"2009","unstructured":"Prakash G, Jhanji V, Smarma N, Gupta K, Titiyal JS, Vajpayee RB (2009) Assessment of perceived difficulties by residents in performing routine steps in phacoemulsification surgery and in managing complications. Can J Ophthalmol 44:284\u2013287","journal-title":"Can J Ophthalmol"},{"key":"7189_CR31","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1055\/s-0038-1676043","volume":"10","author":"A Rali","year":"2018","unstructured":"Rali A, Fontus J, Ward L, Aaron M, Jones J, Moore E et al (2018) Resident stress level during steps of cataract surgery. J Acad Ophthalmol 10:179\u2013184","journal-title":"J Acad Ophthalmol"},{"key":"7189_CR32","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1111\/codi.12844","volume":"17","author":"KI Jones","year":"2015","unstructured":"Jones KI, Amawi F, Bhalla A, Peacock O, Williams JP, Lund JN (2015) Assessing surgeon stress when operating using heart rate variability and the State Trait Anxiety Inventory: will surgery be the death of us? Colorectal Dis 17:335\u2013341","journal-title":"Colorectal Dis"},{"key":"7189_CR33","doi-asserted-by":"publisher","DOI":"10.1093\/bjsopen\/zrae097","volume":"8","author":"CD De Louche","year":"2024","unstructured":"De Louche CD, Mandal M, Fernandes L, Lawson J, Bicknell CD, Pouncey AL (2024) Heart rate variability as a dynamic marker of surgeons\u2019 stress during vascular surgery. BJS Open 8:097","journal-title":"BJS Open"},{"key":"7189_CR34","doi-asserted-by":"publisher","DOI":"10.1080\/19932820.2020.1768024","volume":"15","author":"I Kacem","year":"2020","unstructured":"Kacem I, Kahloul M, El Arem S, Ayachi S, Hafsia M, Maoua M et al (2020) Effects of music therapy on occupational stress and burn-out risk of operating room staff. Libyan J Med 15:1768024","journal-title":"Libyan J Med"}],"container-title":["Graefe's Archive for Clinical and Experimental Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00417-026-07189-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00417-026-07189-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00417-026-07189-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T05:48:18Z","timestamp":1783403298000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00417-026-07189-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,9]]},"references-count":34,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["7189"],"URL":"https:\/\/doi.org\/10.1007\/s00417-026-07189-1","relation":{},"ISSN":["0721-832X","1435-702X"],"issn-type":[{"value":"0721-832X","type":"print"},{"value":"1435-702X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,9]]},"assertion":[{"value":"27 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 March 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 March 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical trial number"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}