Resident laser in situ keratomileusis surgical training in United States residency programs

Corneal Laser Refractive Surgery Curriculum Development in the Military: Using the Nominal Group Technique

INTRODUCTION

Corneal laser refractive surgery (CRS) has emerged over the past three decades as a surgical method for correcting or improving vision. In the military, CRS helps warfighters achieve weapon grade vision, which offers a tactical advantage in the deployed environment. As refractive surgery has become more prevalent in both the military and civilian sector, more ophthalmologists need to learn about treatment options as well as management of complications in order to meet increasing patient demand. Currently, little is known about the most effective curriculum for teaching refractive surgery in training programs, and a standardized curriculum does not exist. Since unification of training programs is a Defense Health Agency priority, this study aimed to collect expert consensus on a standardized curriculum for CRS training in the military.

MATERIALS AND METHODS

To achieve this goal, the Nominal Group Technique (NGT) was used wherein a panel of experts, currently practicing refractive surgeons involved in military refractive surgery training programs, arrived at consensus on a standardized CRS curriculum. The framework for developing this curriculum is based on Kern's Six-Step Approach to Curriculum Development. The International Council of Ophthalmology refractive surgery curriculum, National Curriculum for Ophthalmology Residency Training, Accreditation Council for Graduate Medical Education competencies and surgical minimums, and American Academy of Ophthalmology Refractive Surgery Preferred Practice Guidelines were used as the starting materials from which panelists' consensus was drawn. This consensus-building method allowed for equal representation of experts' ideas and fostered collaboration to aid in the creation of a robust and standardized curriculum for refractive surgery training programs in the military.

RESULTS

The panelist experts from this NGT were able to reach consensus on the components of a standardized military refractive surgery curriculum to include generalized and targeted needs assessment, goals and objectives, educational strategies, and curriculum implementation.

CONCLUSION

A standardized CRS curriculum is warranted in military training programs. This NGT achieved expert consensus on the goals, objectives, educational methods, and implementation strategies for a standardized CRS curriculum in military ophthalmology residency.

Visual and Refractive Outcomes Following SMILE to Correct Myopia Performed by Surgeons in Training

PURPOSE

To assess visual outcomes and complications following small incision lenticule extraction (SMILE) performed by cornea fellows under the supervision of experienced surgeons.

METHODS

This retrospective, noncomparative case series was designed to assess outcomes following SMILE procedures performed at a large surgical center by cornea fellows between May 1, 2012 and March 30, 2015. Preoperative and postoperative uncorrected distance visual acuity (UDVA), preoperative and postoperative corrected distance visual acuity (CDVA), spherical equivalent (SE) up to -10.00 diopters (D), and complications were recorded.

RESULTS

A total of 114 patients (228 eyes) met the inclusion criteria. The mean preoperative SE was -5.79 ± 1.95 D (range: -1.75 to -10.00 D) and the mean cylinder was -2.21 ± 1.43 D (range: 0.00 to -5.50 D). At the last follow-up visit (average: 6.4 months), 94% of the patients achieved a UDVA of 20/30 or better and 96% of the patients achieved stability in their vision. Adverse events were encountered in 40 eyes (17.5%), with epithelial defect being the most common. Two patients required a second intervention to improve visual outcomes.

CONCLUSIONS

SMILE performed by cornea fellows under the supervision of an experienced surgeon is an effective and safe refractive procedure with a short learning curve and excellent visual outcomes. [J Refract Surg. 2022;38(1):28-34.].

Outcomes of Resident-Performed FS-LASIK for Myopia and Myopic Astigmatism

PURPOSE

To evaluate the outcomes of resident-performed femtosecond laser-assisted in situ keratomileusis (FS-LASIK).

METHODS

Records of 138 eyes of 69 patients treated by residents for myopia or myopic astigmatism between March 2018 and June 2020 were reviewed. All preoperative visits, procedures, and postoperative visits were supervised by attending physicians. Follow-up examinations were performed 1 day and 1 month postoperatively. Complications and enhancements were noted. Outcome measures included postoperative uncorrected distance visual acuity (UDVA), refractive accuracy, and complications.

RESULTS

Eighteen residents performed FS-LASIK on a median of 8 eyes (interquartile range: 1.75). Fifty-nine patients (118 eyes) returned for a 1-month postoperative examination. UDVA was 20/40 or better in 117 eyes (99%) and 20/20 or better in 108 eyes (92%). The mean preoperative spherical equivalent (SE) refractive error was -4.01 ± 1.82 diopters (D) in 138 eyes, decreasing to -0.12 ± 0.35 D at 1 month after surgery in the 102 eyes that were refracted. The SE was ±1.00 D in 100 eyes (98%) and ±0.50 D in 94 eyes (93%). The CDVA change was within one line in 100% of eyes. Intraoperative complications occurred in 5 eyes (3.62%), enhancements were performed in 3 eyes (2.17%), and postoperative complications developed in 3 eyes (2.17%).

CONCLUSIONS

Resident-performed FS-LASIK is relatively safe and effective in comparison to published U.S. Food and Drug Administration premarket approval studies. Early resident experience performing LASIK can improve the training of ophthalmic surgeons while simultaneously increasing patient access to laser vision correction. [J Refract Surg. 2021;37(8):545-551.].

Femto-LASIK outcomes obtained by a fellowship trainee during a refractive surgery training program

PURPOSE

To report, for the first time, the clinical outcomes and patient satisfaction of laser refractive surgery performed by a trainee during a corneal and refractive surgery fellowship program in Latin America.

METHODS

This prospective and interventionist study reviewed the clinical charts of the first 100 consecutive refractive surgery cases performed by a single Cornea Fellowship trainee between March 2018 and June 2018 in the Blindness Prevention Association of Mexico (Asociación para Evitar la Ceguera en Mexico). Femtosecond LASIK was performed in all eyes. Visual and refractive outcomes were evaluated during the first year of follow-up. Patient satisfaction was measured using 5 author-created questions 6 months after surgery.

RESULTS

Data of 100 eyes of 50 consecutive patients were evaluated. One year after the surgery, mean uncorrected distance visual acuity (UDVA) was 0.01 logMAR. Spherical equivalent error passed from -3.91 ± 2.28 D preoperatively to -0.22 ± 0.28 D. No eyes lost lines in corrected distance visual acuity (CDVA). Manifest refraction maintained stable during the first year after surgery. The five author-created questions revealed a high level of confidence and patient satisfaction.

CONCLUSIONS

Femto-LASIK performed by a corneal and refractive surgery fellowship trainee showed good refractive and visual outcomes, as well as high patient satisfaction and confidence in a refractive surgery centre in Latin America.

Femto-LASIK outcomes obtained by a fellowship trainee during a refractive surgery training program

PURPOSE

To report, for the first time, the clinical outcomes and patient satisfaction of laser refractive surgery performed by a trainee during a corneal and refractive surgery fellowship program in Latin America.

METHODS

This prospective and interventionist study reviewed the clinical charts of the first 100 consecutive refractive surgery cases performed by a single Cornea Fellowship trainee between March 2018 and June 2018 in the Blindness Prevention Association of Mexico (Asociación para Evitar la Ceguera en Mexico). Femtosecond LASIK was performed in all eyes. Visual and refractive outcomes were evaluated during the first year of follow-up. Patient satisfaction was measured using 5 author-created questions 6 months after surgery.

RESULTS

Data of 100 eyes of 50 consecutive patients were evaluated. One year after the surgery, mean uncorrected distance visual acuity (UDVA) was 0.01logMAR. Spherical equivalent error passed from -3.91±2.28D preoperatively to -0.22±0.28D. No eyes lost lines in corrected distance visual acuity (CDVA). Manifest refraction maintained stable during the first year after surgery. The five author-created questions revealed a high level of confidence and patient satisfaction.

CONCLUSIONS

Femto-LASIK performed by a corneal and refractive surgery fellowship trainee showed good refractive and visual outcomes, as well as high patient satisfaction and confidence in a refractive surgery centre in Latin America.

The impact of surgical training on the practice of recently graduated ophthalmologists at Riyadh’s ophthalmology residency program

Purpose

Methods

Results

Conclusion

Trends in cataract surgery training curricula

PURPOSE

To evaluate trends in cataract surgery training curricula and factors affecting timing of resident participation as a primary surgeon.

SETTING

Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA.

DESIGN

Cross-sectional study of anonymous survey results.

METHODS

A description of the study and link to an online survey was e-mailed to program directors of each ophthalmology residency training program accredited by the Accreditation Council for Graduate Medical Education (ACGME).

RESULTS

Fifty-one (44%) of the 116 program directors completed the survey. First-year, second-year, and third-year residents performed a mean of 2, 25, and 155 phacoemulsification surgeries, respectively, as a primary surgeon. Only 1 program (2%) required residents to perform extracapsular cataract extraction (ECCE) before performing phacoemulsification. Clear corneal phacoemulsification was the first technique taught to trainees at 91% of programs. More than two thirds (71%) of program directors indicated that their program had a cataract surgery training curriculum designed to transition residents gradually to the operating room. These curricula included structured wet laboratory (92%) and lecture (89%) components. Inadequate resident knowledge and surgical skill base (57%) and anticipation of increased surgical complication risk (37%) were the most commonly reported factors impeding earlier exposure to phacoemulsification in residency.

CONCLUSIONS

Results show that residents today begin surgical training with phacoemulsification rather than ECCE, perform a higher number of phacoemulsification surgeries than is required by the ACGME, and begin performing phacoemulsification as early as their first or second year of residency. Despite these evolutions, 29% of respondent ACGME-accredited ophthalmology residency programs reported not having a formal cataract surgery training curriculum.

Refractive surgery training during residency - do not be afraid of the dark

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.

Resident surgical experience with lens and corneal refractive surgery: survey of the ASCRS Young Physicians and Residents Membership

A 43-question survey was e-mailed to all resident members of the American Society of Cataract and Refractive Surgery (ASCRS), ASCRS members in practice for 5 or fewer years, and residency program directors of 118 U.S. Accreditation Council for Graduate Medical Education-accredited ophthalmology programs (for distribution to their residents) in June 2010. Two hundred eighty-five of 2279 surveys sent were completed and returned, for a response rate of 12.5%. Most respondents (88.7%) had served as primary surgeon in more than 100 cataract surgeries. Fifty-two percent of respondents had not performed corneal relaxing incisions; 60% had no experience implanting a toric IOL. Twenty-two percent had experience implanting a presbyopia-correcting IOL. Over 75% had not performed any corneal refractive surgical procedures. Although basic cataract case numbers appear adequate, there are significant perceived deficiencies in current resident training models for surgical astigmatism management, implanting presbyopia-correcting IOLs, and corneal refractive surgery.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Resident laser refractive surgery training

PURPOSE OF REVIEW

The Residency Review Committee Ophthalmology of the Accreditation Council for Graduate Medical Education has recently established guidelines pertaining to the minimum operative requirements for training ophthalmology residents in refractive surgery. Despite being one of the most frequently performed ophthalmic surgical procedures, there is a paucity of literature on residency training in refractive surgery. Moreover, the literature indicates that only half of training programs offer surgical exposure to trainees. The purpose of this article is to review recent research on training ophthalmology residents in refractive surgery and offer an approach to incorporating laser refractive surgery curriculum in residency education.

RECENT FINDINGS

Kwon et al. performed a national survey to evaluate current trends in resident laser in-situ keratomileusis (LASIK) training in the USA. The result shows that 54% of respondents had resident-performed LASIK surgery with 9.1% of surveyed programs not offering any LASIK experience. In addition, residents in the study performed a mean of 4.4 LASIK surgeries (range 1-10) during residency training starting during the second year.

SUMMARY

The data emerging from the survey show that refractive surgery experience is fundamental to the education of the ophthalmology resident. Although the demand for refractive surgery continues to gain pace with millions of such procedures performed worldwide, only a little over half of ophthalmology residency programs offer residents the opportunity to gain surgical experience. With the current mandate, programs must now look for strategies to provide laser refractive surgical experience to residents.