Residency training in refractive surgery

From Walter Reed National Military Medical Center (Weber, Stutzman, Mines, Eiseman, Wroblewski), Bethesda, Maryland, United States Army Warfighter Refractive Surgery Research Center at Fort Belvoir (Ryan, Sia), Fort Belvoir, Virginia, and the Wilmer Eye Institute (Bower), Johns Hopkins University, Baltimore, Maryland, USA. Electronic address: .
Journal of Cataract and Refractive Surgery (Impact Factor: 2.72). 11/2012; 38(11):1962-9. DOI: 10.1016/j.jcrs.2012.06.055
Source: PubMed


To evaluate resident refractive surgery caseload and surgical outcomes in an academic medical center.
Walter Reed Army Medical Center, Washington, DC, USA.
Comparative case study.
Keratorefractive procedures performed by residents at the Walter Reed Center for Refractive Surgery between 2002 and 2010 were reviewed. Outcomes of surgeries performed by the graduating classes of 2008 to 2010 were compared with those of cases performed by staff. The uncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent, corrected distance visual acuity (CDVA), and complications were analyzed.
Between 2002 and June 2010, residents performed 1566 procedures (1414 photorefractive keratectomy [PRK], 152 laser in situ keratomileusis), for a mean of 20.2 procedures from 2002 to 2004, 51.6 from 2005 to 2007, and 99.9 from 2008 to 2010. Outcomes analysis was performed on 333 resident eyes and 977 staff eyes treated between 2008 and June 2010. Six months postoperatively, 96.1% of resident-treated eyes and 94.6% of staff-treated eyes had a UDVA 20/20 or better (P=.312) and 61.3% and 64.3%, respectively, had a UDVA 20/15 or better (P=.324). The percentage of eyes within ±0.50 diopter of emmetropia at 6 months was 94.0% for residents and 91.1% for staff (P=.105). The postoperative CDVA was within 2 lines of preoperative baseline in all resident cases and 99.8% of staff cases (P=.999).
Resident experience grew steadily over the period studied. Overall safety and efficacy of resident-performed surgery, albeit mainly PRK based, matched that of fellowship-trained refractive surgeons.
No author has a financial or proprietary interest in any material or method mentioned.

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    ABSTRACT: Refractive errors are a fairly common eye condition worldwide, and the ophthalmologist should be capable of offering the patient both nonsurgical and surgical solutions to their refractive conditions. Nevertheless, currently, refractive surgery training during residency is poor at best. This paper explores recent evidence to suggest that postsurgical results of patients operated on by residents are not inferior to those operated on by experienced staff. It points out the urgent need to improve the current approach to refractive surgery training.
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    ABSTRACT: Purpose: To evaluate the refractive error quality of life (RQL) improvement, patient satisfaction, and clinical results of laser refractive surgery performed by residents or fellows. Setting: Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, USA. Design: Case series. Methods: This study reviewed the clinical results of consecutive refractive surgery cases performed between March 2010 and February 2012 by ophthalmology residents or fellows. One-year postoperative analysis of the RQL and patient satisfaction in a subgroup of patients was completed using the National Eye Institute Refractive Error Correction Quality of Life-42 instrument (NEI RQL-42), and a comparison with NEI published normative data and post-refractive data was performed. Results: Data were obtained from 138 eyes that had laser in situ keratomileusis and 4 eyes that had photorefractive keratectomy. The 1-year postoperative analysis of the RQL and patient satisfaction was completed in 34 patients. After 6 months postoperatively, the mean uncorrected distance visual acuity was 0.01 logMAR (95% confidence interval [CI], -0.012 to 0.023). The mean postoperative residual refractive error spherical equivalent was -0.20 diopter (D) (95% CI, -0.26 to -0.13). No eye lost corrected distance visual acuity. Equivalent or better satisfaction in the RQL was found in all but 1 of the 13 scale scores of the NEI RQL-42 compared with previously published NEI data. Conclusions: Laser refractive surgery performed by residents and fellows showed high patient satisfaction and an improved RQL 1-year postoperatively. Clinical outcomes validated the safety and efficacy of refractive surgery performed by surgeons in training. Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.
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