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Meer E, Davidson K, Ingenito KH, Brodie F, Schallhorn JM. A survey of perceptions of exposure to new technology in residents and practicing ophthalmologists. BMC Ophthalmol 2024; 24:142. [PMID: 38549055 PMCID: PMC10976830 DOI: 10.1186/s12886-024-03378-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/04/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Incorporation of the rapid advances in ophthalmologic surgical and diagnostic techniques inherent in the field poses a challenge to residency training programs. This study investigates exposure to new technologies during residency and perception of its impact on practice patterns. METHODS Ophthalmology residents at various training levels and practicing ophthalmologists who had completed their training were invited to participate in a survey study assessing exposure to various technologies in residency and in practice. Data collection occurred from December 2022 to June 2023. Descriptive statistics were performed. RESULTS The study received 132 unique responses, including 63 ophthalmology residents and 69 practicing ophthalmologists. 65.2% (n = 45) of practicing ophthalmologists and 47.6% (n = 30) of current residents reported discussion/training on newly developed products on the market (e.g. premium IOLS, MIGS), was "minimally discussed but not emphasized" or "not discussed at all" in residency. 55.1% (n = 38) of practicing ophthalmologists reported that exposure to new technologies during residency did influence types of technologies employed during practice. The majority resident physicians reported enjoying being trained on newer technology and feeling more prepared for future changes in the field (95.2%, n = 60) and felt that having industry partnerships in residency enhances education and training (90.5%, n = 57). CONCLUSIONS Considering how to maximize exposure to newer technologies/devices during residency training is important, and may contribute to training more confident, adaptable surgeons, who are more likely to critically consider new technologies and adopt promising ones into their future clinical practice.
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Affiliation(s)
- Elana Meer
- Department of Ophthalmology, University of California, San Francisco, 490 Illinois Street, 94158, San Francisco, CA, USA
| | | | | | - Frank Brodie
- Department of Ophthalmology, University of California, San Francisco, 490 Illinois Street, 94158, San Francisco, CA, USA
| | - Julie M Schallhorn
- Department of Ophthalmology, University of California, San Francisco, 490 Illinois Street, 94158, San Francisco, CA, USA.
- Francis I Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, CA, USA.
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Cleland SC, Knoch DW, Larson JC. Outcomes of Femtosecond Laser Assisted Cataract Surgery Performed by Resident and Attending Surgeons. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2021. [DOI: 10.1055/s-0041-1725582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Abstract
Objective The study aimed to evaluate the safety and efficacy of resident surgeons performing femtosecond laser assisted cataract surgery (FLACS).
Methods A retrospective chart review was conducted at the University of Wisconsin-Madison from postgraduate year four residents performing FLACS between 2017 and 2019. Data were also collected from residents performing manual cataract surgery, and attending surgeons performing FLACS for comparison. Recorded data included patient demographics, pre- and postoperative visual acuity, pre- and postoperative spherical equivalent, nuclear sclerotic cataract grade, ocular and systemic comorbidities, intraocular lens, duration of surgery, cumulative dissipated energy (CDE), and intraoperative and postoperative complications.
Results A total of 90 cases were reviewed with 30 resident manual cases, 30 resident FLACS cases, and 30 attending FLACS cases. Resident manual (25.5 ± 6.8 minutes) and resident FLACS (17.5 ± 7.1 minutes) cases took a significantly longer time to complete compared with attending FLACS cases (13.6 ± 4.4 minutes; p < 0.001). There was higher CDE in resident FLACS and resident manual cases compared with attending FLACS cases, but the difference was not statistically significant (p = 0.06). Postoperative visual acuity was not statistically different at 1-day and 1-month after surgery among the three groups. Resident FLACS complications, which included one case requiring an intraoperative suture to close the wound, two cases with intraoperative corneal abrasions, two cases with postoperative ocular hypertension, and one case with cystoid macular edema, were not significantly greater than attending FLACS complications (p = 0.30).
Conclusion The FLACS performed by resident surgeons had comparable visual acuity outcomes to FLACS performed by attending surgeons, and to manual cataract surgery performed by resident surgeons. However, resident FLACS cases took significantly longer time to complete, and they were associated with a higher CDE and minor complication rate compared with attending FLACS cases. Introducing advanced technologies into surgical training curricula improves resident preparedness for independent practice, and this study suggests FLACS can be incorporated safely and effectively into resident education.
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Affiliation(s)
- Spencer C. Cleland
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Daniel W. Knoch
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jennifer C. Larson
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin
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Poyales F, Poyales B, Medel D, López-Brea I, López-Artero E, Garzón N. The influence of surgeons and technicians on the learning curve of femtosecond-laser cataract surgery. JOURNAL OF OPTOMETRY 2020; 13:242-248. [PMID: 32009001 PMCID: PMC7520525 DOI: 10.1016/j.optom.2020.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE To demonstrate the influence of the surgeon's and the operating room (OR) technicians' experience upon the outcome of femtosecond laser-assisted cataract surgery (FLACS). MATERIALS AND METHODS Our study included 250 eyes from 156 patients who had undergone either cataract surgery or clear-crystalline-lens extraction and where capsulorhexis and lens fragmentation had been performed using the CATALYS® Precision System femtosecond platform (Abbott Medical Optics Inc., Santa Ana, CA, USA).The patients were operated either by an experienced surgeon in the use of femtosecond laser or by an inexperienced surgeon in that field and two technicians. The quantitative outcome measures were: Suction loss rate, vacuum time, number of consumables used by the patient and intraoperative complication rate. RESULTS Both for the experienced and the inexperienced surgeons, suction loss rates as well as vacuum time decreased progressively as time went by and more surgical procedures had been completed by that surgeon. For a given surgeon suction time decreased significantly, going from 137 to 99s, as the assisting technician gradually gained experience. The number of consumables used in each procedure by the experienced surgeon ranged from 1.10 (for the first 50 cases) to 1.02 from those initial cases onwards. Regarding intraoperative complications, they also decreased progressively as the number of procedures completed by the surgeon increased. CONCLUSIONS The experience of each team member involved in such procedures-be it surgeons or technicians-have an impact, to a greater or lesser extent, upon the surgery's outcome, as quantified by the outcome variables of choice.
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Affiliation(s)
| | | | - David Medel
- Miranza IOA Madrid, c/Galileo 104 Madrid, Spain
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Nath M, Gireesh P. Femtosecond laser-assisted cataract surgery in Alport's syndrome - A case report. Indian J Ophthalmol 2020; 67:1891-1893. [PMID: 31638065 PMCID: PMC6836590 DOI: 10.4103/ijo.ijo_586_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Alport's syndrome with anterior lenticonus poses significant challenges during capsulorhexis with high chances of peripheral extension. We report a case of 23-year-old lady with Alport's syndrome with anterior lenticonus in the left eye that underwent successful femtosecond laser-assisted cataract surgery (FLACS). The anterior lenticonus was eccentric nasally; hence, the FLACS capsulotomy was positioned slightly nasally so that the capsulotomy margin was outside the cone base. The distance vision improved from 6/24 to 6/6 at one-month follow-up. In summary, FLACS improved the safety of cataract surgery in an eye with anterior lenticonus and yielded excellent visual outcomes.
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Affiliation(s)
- Manas Nath
- Department of Cataract Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
| | - Prasanth Gireesh
- Department of Cataract Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
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Suryawanshi MP, Alsaidi R. Femtosecond laser-assisted cataract surgery. Oman J Ophthalmol 2020; 13:1-2. [PMID: 32174732 PMCID: PMC7050459 DOI: 10.4103/ojo.ojo_279_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 11/04/2022] Open
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Comparison of phacoemulsification parameters between manual and femtosecond laser-assisted cataract surgery. Can J Ophthalmol 2018; 53:542-547. [DOI: 10.1016/j.jcjo.2018.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 12/29/2017] [Accepted: 01/03/2018] [Indexed: 11/20/2022]
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Levitz L, Reich J, Hodge C. Posterior capsular complication rates with femtosecond laser-assisted cataract surgery: a consecutive comparative cohort and literature review. Clin Ophthalmol 2018; 12:1701-1706. [PMID: 30233133 PMCID: PMC6134952 DOI: 10.2147/opth.s173089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of the study was to determine whether femtosecond-assisted laser cataract surgery (FLACS) reduces the posterior capsular complication (PCC) rate compared to manual cataract surgery when performed by an experienced surgeon. Patients and methods We reviewed 2,021 consecutive FLACS procedures between 1 June 2012 and 30 August 2017. All cases of posterior capsular rupture (PCR) with or without vitreous prolapse or zonular dialysis (ZD) that prevented an in-the-bag placement of the intraocular lens were included. Risk factors were noted and outcomes documented. Results Six eyes of 2,021 (0.3%) who underwent FLACS had either a PCR or ZD. One eye (0.25%) of 403 eyes that had manual cataract surgery had a PCR. There was no significant difference in outcomes. Risk factors included advanced age, dense nuclei, pseudoexfoliation and small pupil. Only a single case in the FLACS series may have been directly attributed to the FLACS procedure. Conclusion This study provides evidence that there is no significant difference in the PCC rate between FLACS and manual cataract surgery in the hand of an experienced surgeon who performs >350 cases annually. This low rate of complications may be achieved by less experienced surgeons adopting FLACS.
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Affiliation(s)
- Lewis Levitz
- Vision Eye Institute Camberwell, Hawthorn East, VIC, Australia,
| | - Joseph Reich
- Vision Eye Institute Camberwell, Hawthorn East, VIC, Australia,
| | - Chris Hodge
- Vision Eye Institute Camberwell, Hawthorn East, VIC, Australia, .,Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
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Kaplowitz K, Yazdanie M, Abazari A. A review of teaching methods and outcomes of resident phacoemulsification. Surv Ophthalmol 2018; 63:257-267. [DOI: 10.1016/j.survophthal.2017.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
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Aslan F, Yuce B, Oztas Z, Ates H. Evaluation of the learning curve of non-penetrating glaucoma surgery. Int Ophthalmol 2017; 38:2005-2012. [PMID: 28801700 DOI: 10.1007/s10792-017-0691-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the learning curve of non-penetrating glaucoma surgery (NPGS). METHODS The study included 32 eyes of 27 patients' (20 male and 7 female) with medically uncontrolled glaucoma. Non-penetrating glaucoma surgeries performed by trainees under control of an experienced surgeon between 2005 and 2007 at our tertiary referral hospital were evaluated. Residents were separated into two groups. Humanistic training model applied to the one in the first group, he studied with experimental models before performing NPGS. Two residents in the second group performed NPGS after a conventional training model. Surgeries of the residents were recorded on video and intraoperative parameters were scored by the experienced surgeon at the end of the study. Postoperative intraocular pressure, absolute and total success rates were analyzed. RESULTS In the first group 19 eyes of 16 patients and in the second group 13 eyes of 11 patients had been operated by residents. Intraoperative parameters and complication rates were not statistically significant between groups (p > 0.05, Chi-square). The duration of surgery was 32.7 ± 5.6 min in the first group and 45 ± 3.8 min in the second group. The difference was statistically significant (p < 0.001, Student's t test). Absolute and total success was 68.8 and 93.8% in the first group and 62.5 and 87.5% in the second group, respectively. The difference was not statistically significant. CONCLUSIONS Humanistic and conventional training models under control of an experienced surgeon are safe and effective for senior residents who manage phacoemulsification surgery in routine cataract cases. Senior residents can practice these surgical techniques with reasonable complication rates.
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Affiliation(s)
- Fatih Aslan
- Department of Ophthalmology, Faculty of Medicine, Ege University, Bornova, 35040, Izmir, Turkey
| | - Berna Yuce
- Department of Ophthalmology, Faculty of Medicine, Ege University, Bornova, 35040, Izmir, Turkey
| | - Zafer Oztas
- Department of Ophthalmology, Faculty of Medicine, Ege University, Bornova, 35040, Izmir, Turkey.
| | - Halil Ates
- Department of Ophthalmology, Faculty of Medicine, Ege University, Bornova, 35040, Izmir, Turkey
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Resident and young physician experience with complex cataract surgery and new cataract and refractive technology: Results of the ASCRS 2016 Young Eye Surgeons survey. J Cataract Refract Surg 2017; 43:687-694. [DOI: 10.1016/j.jcrs.2017.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/17/2017] [Indexed: 11/23/2022]
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Roberts HW, Ni MZ, O'Brart DPS. Financial modelling of femtosecond laser-assisted cataract surgery within the National Health Service using a 'hub and spoke' model for the delivery of high-volume cataract surgery. BMJ Open 2017; 7:e013616. [PMID: 28302635 PMCID: PMC5372035 DOI: 10.1136/bmjopen-2016-013616] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS To develop financial models which offset additional costs associated with femtosecond laser (FL)-assisted cataract surgery (FLACS) against improvements in productivity and to determine important factors relating to its implementation into the National Health Service (NHS). METHODS FL platforms are expensive, in initial purchase and running costs. The additional costs associated with FL technology might be offset by an increase in surgical efficiency. Using a 'hub and spoke' model to provide high-volume cataract surgery, we designed a financial model, comparing FLACS against conventional phacoemulsification surgery (CPS). The model was populated with averaged financial data from 4 NHS foundation trusts and 4 commercial organisations manufacturing FL platforms. We tested our model with sensitivity and threshold analyses to allow for variations or uncertainties. RESULTS The averaged weekly workload for cataract surgery using our hub and spoke model required either 8 or 5.4 theatre sessions with CPS or FLACS, respectively. Despite reduced theatre utilisation, CPS (average £433/case) was still found to be 8.7% cheaper than FLACS (average £502/case). The greatest associated cost of FLACS was the patient interface (PI) (average £135/case). Sensitivity analyses demonstrated that FLACS could be less expensive than CPS, but only if increased efficiency, in terms of cataract procedures per theatre list, increased by over 100%, or if the cost of the PI was reduced by almost 70%. CONCLUSIONS The financial viability of FLACS within the NHS is currently precluded by the cost of the PI and the lack of knowledge regarding any gains in operational efficiency.
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Affiliation(s)
- H W Roberts
- Department of Ophthalmology, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - M Z Ni
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - D P S O'Brart
- Department of Ophthalmology, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- King's College London, London, UK
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Pittner AC, Sullivan BR. Resident surgeon efficiency in femtosecond laser-assisted cataract surgery. Clin Ophthalmol 2017; 11:291-297. [PMID: 28203055 PMCID: PMC5298295 DOI: 10.2147/opth.s128626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose Comparison of resident surgeon performance efficiencies in femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification. Patients and methods A retrospective cohort study was conducted on consecutive patients undergoing phacoemulsification cataract surgery performed by senior ophthalmology residents under the supervision of 1 attending physician during a 9-month period in a large Veterans Affairs medical center. Medical records were reviewed for demographic information, preoperative nucleus grade, femtosecond laser pretreatment, operative procedure times, total operating room times, and surgical complications. Review of digital video records provided quantitative interval measurements of core steps of the procedures, including completion of incisions, anterior capsulotomy, nucleus removal, cortical removal, and intraocular lens implantation. Results Total room time, operation time, and corneal incision completion time were found to be significantly longer in the femtosecond laser group versus the traditional phacoemulsification group (each P<0.05). Mean duration for manual completion of anterior capsulotomy was shorter in the laser group (P<0.001). There were no statistically significant differences in the individual steps of nucleus removal, cortical removal, or intraocular lens placement. Surgical complication rates were not significantly different between the groups. Conclusion In early cases, resident completion of femtosecond cataract surgery is generally less efficient when trainees have more experience with traditional phacoemulsification. FLACS was found to have a significant advantage in completion of capsulotomy, but subsequent surgical steps were not shorter or longer. Resident learning curve for the FLACS technology may partially explain the disparities of performance. Educators should be cognizant of a potential for lower procedural efficiency when introducing FLACS into resident training.
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Affiliation(s)
- Andrew C Pittner
- Department of Ophthalmology, Stritch School of Medicine, Loyola University Chicago, Maywood
| | - Brian R Sullivan
- Edward Hines Jr VA Hospital, Ophthalmology Section, Hines, IL, USA
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Outcomes of femtosecond laser-assisted cataract surgery performed by surgeons-in-training. Graefes Arch Clin Exp Ophthalmol 2017; 255:805-809. [DOI: 10.1007/s00417-016-3581-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 12/18/2016] [Accepted: 12/29/2016] [Indexed: 10/20/2022] Open
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Abdelfattah NS, Radwan AE, Sadda SR. Perspective of ophthalmology residents in the United States about residency programs and competency in relation to the International Council of Ophthalmology guidelines. J Curr Ophthalmol 2016; 28:146-51. [PMID: 27579460 PMCID: PMC4992122 DOI: 10.1016/j.joco.2016.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/01/2016] [Indexed: 12/04/2022] Open
Abstract
PURPOSE To evaluate the perspective of ophthalmology residents in the US about their residency programs and compare the competency of residency programs to international competency levels set by the International Council of Ophthalmology (ICO). METHODS A cross-sectional web-based survey extracted from the ICO published competency standards was sent to program directors of ophthalmology residency programs in the US to forward it to current PGY-3, 4 residents, and residency graduates from 2011 to 2014. RESULTS Eighty-seven responses were received, comprising 61 residents and 26 graduates. Most respondents were highly satisfied with their programs (93.6%). Clinic-based training was rated satisfactorily. Insufficient exposure to low-vision rehabilitation (38.5%), refraction and contact lenses prescription (38.5%), and vitreo-retinal surgeries (38.5%) was reported. Respondents were satisfied with their overall surgical experiences, with the vast majority (>83%) rating case volume, complexity, and variety as satisfactory or better. A significant group stated they had insufficient exposure to extra-capsular cataract extraction (26.3%), refractive surgery (19.7%), and orbital surgery (64.5%). All graduates surveyed passed their Ophthalmic Knowledge Assessment Program (OKAP) examinations, and 72% felt their residency programs adequately prepared them for the examinations. All respondents reported insufficient training in certain nonclinical areas, such as practice management, staffing, and administration skills. CONCLUSIONS Ophthalmology residents in the US express high levels of satisfaction with their residency training programs. While most programs adequately address most ICO core objectives, certain curriculum modifications should be considered.
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Affiliation(s)
- Nizar Saleh Abdelfattah
- Doheny Eye Institute, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Ahmed E. Radwan
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Srinivas R. Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California Los Angeles, CA, USA
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Day AC, Dhallu SK, Maurino V, Wilkins MR. Initial experience using a femtosecond laser cataract surgery system at a UK National Health Service cataract surgery day care centre. BMJ Open 2016; 6:e012078. [PMID: 27466243 PMCID: PMC4964168 DOI: 10.1136/bmjopen-2016-012078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To describe the initial outcomes following installation of a cataract surgery laser system. SETTING National Health Service cataract surgery day care unit in North London, UK. PARTICIPANTS 158 eyes of 150 patients undergoing laser-assisted cataract surgery. INTERVENTIONS Laser cataract surgery using the AMO Catalys femtosecond laser platform. PRIMARY OUTCOME MEASURE intraoperative complications including anterior and posterior capsule tears. SECONDARY OUTCOME MEASURES docking to the laser platform, successful treatment delivery, postoperative visual acuities. RESULTS Mean case age was 67.7±10.8 years (range 29-88 years). Docking was successful in 94% (148/158 cases), and in 4% (6/148 cases) of these, the laser delivery was aborted part way during delivery due to patient movement. A total of 32 surgeons, of grades from junior trainee to consultant, performed the surgeries. Median case number per surgeon was 3 (range from 1-20). The anterior capsulotomy was complete in 99.3% of cases, there were no anterior capsule tears (0%). There were 3 cases with posterior capsule rupture requiring anterior vitrectomy, and 1 with zonular dialysis requiring anterior vitrectomy (4/148 eyes, 2.7%). These 4 cases were performed by trainee surgeons, and were either their first laser cataract surgery (2 surgeons) or their first and second laser cataract surgeries (1 surgeon). CONCLUSIONS Despite the learning curve, docking and laser delivery were successfully performed in almost all cases, and surgical complication rates and visual outcomes were similar to those expected based on national data. Complications were predominately confined to trainee surgeons, and with the exception of intraoperative pupil constriction appeared unrelated to the laser-performed steps.
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Affiliation(s)
- Alexander C Day
- The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Cataract Service, Moorfields Eye Hospital, London, UK
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Femtosecond laser-assisted cataract surgery--current status and future directions. Surv Ophthalmol 2015; 61:103-31. [PMID: 26409902 DOI: 10.1016/j.survophthal.2015.09.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 09/11/2015] [Accepted: 09/14/2015] [Indexed: 02/04/2023]
Abstract
Femtosecond laser-assisted cataract surgery (FLACS) putatively offers several advantages over conventional phacoemulsification. We review the current status of FLACS and discuss the evolution of femtosecond lasers in cataract surgery and the currently available femtosecond laser platforms. We summarize the outcomes of FLACS for corneal wound creation, limbal relaxing incisions, capsulotomy, and lens fragmentation. We discuss surgical planning, preoperative considerations, clinical experiences including the learning curve and postoperative outcomes with FLACS, and also the cost effectiveness of FLACS. We present the intraoperative complications and management of challenging cases where FLACS offers an advantage and also speculate on the future directions with FLACS. Further advancements in laser technology to refine its efficacy, advancement in intraocular lens design to harness the potential benefits of FLACS, and a reduction in cost are needed to establish a clear superiority over conventional phacoemulsification.
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Affiliation(s)
- Joanne W Ho
- Shiley Eye Center, University of California, San Diego, La Jolla, California, USA
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Cowan LA, Kloek C. Introducing a New Surgical Technology: Controversies in Femtosecond Laser-assisted Cataract Surgery and Impact on Resident Surgical Training. Int Ophthalmol Clin 2015; 55:23-35. [PMID: 26322423 DOI: 10.1097/iio.0000000000000093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Femtosecond laser-assisted cataract surgery is becoming more widely available as an option for patients considering cataract surgery. Controversies exist around determining the best platform for LCS, the potential global role and cost to the health care system of LCS, as well as the future of LCS in resident surgical training.
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