Purchase this article with an account.
Gopal Desai, Elliot S Crane, Marco A Zarbin, Neelakshi Bhagat; Resident v. Attending Surgical Outcomes: Demarcation Laser Photocoagulation. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5986.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To compare anatomic and functional outcomes of demarcation laser photocoagulation (DLP) for retinal pathology performed by fellowship-trained retina specialists (“attendings”) to those performed by residents under direct supervision of an attending (“residents”).
A retrospective review of all DLPs (CPT: 67415) performed from 2006 to 2016 at the ambulatory clinic at the Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School (NJMS). Failure, the primary outcome measure, was defined as: development of a retinal detachment (RD) within 3 months of DLP, need for additional laser treatment to the same retinal break, or vision loss due to a complication. Secondary outcome measures included changes in best-corrected visual acuity (BCVA) calculated using modified LogMAR. Calculations were done with Microsoft Excel and Graphpad. Statistical analysis included t- and Fisher’s exact tests; α=0.05.
One hundred sixty eyes (146 subjects) met inclusion criteria (86 male [54%], mean ± standard deviation (SD) age 52 ± 17 years at DLP, mean ± SD follow up 3.3 ± 2.5 years). Of 160 eyes, 68 (43%) were treated by attendings and 92 (53%) were treated by residents. Treatment indications varied: 71 (44%) tears (67% horseshoe, 33% operculated), 56 (35%) atrophic holes, and 16 (10%) lattice degeneration. One (1%) resident-treated eye and one (2%) attending-treated eye met failure criteria due to RD (P=1.00). Nine (11%) resident-treated eyes and two (3%) attending-treated eyes met the failure criterion of repeat treatment to the same spot (P=0.11). There were no instances of vision loss due to complications of laser treatment. The mean ± SD change in LogMAR BCVA at 3 months was -0.006 ± 0.39 for resident-treated eyes and -0.019 ± 0.23 for attending-treated eyes (P=0.844). Other postoperative complications within 3 months included: new retinal hole/tear (7, 4%), vitreous hemorrhage (4, 3%), retinal hemorrhage (3, 2%), posterior vitreous detachment (8, 5%), and epiretinal membrane (2, 1%).
As quality measures become increasingly prevalent, the relationship between providing high-quality patient care and resident education must be investigated. This retrospective review of 160 eyes undergoing DLP at Rutgers-NJMS demonstrates that when residents are supervised by fellowship-trained attendings, there is no significant difference in anatomic outcome between attending- and resident-performed DLP.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only