Abstract
Purpose: :
Refractive surgery training in United States ophthalmology residencies is growing. This study reports the clinical outcomes of refractive surgeries by residents at a single institution.
Methods: :
This retrospective review included refractive surgery cases by residents from 12/2003 to 2/2010. During this period, cases were supervised by a single attending (M.R.) at a single site. The resident surgeons attended a certification course and acted as primary surgeon on 10 eyes. Only patients with bilateral procedures were included. Each patient was evaluated and found to be a candidate for refractive surgery. Patients were informed of resident’s role and received a discounted rate. Their sex, age, preoperative cycloplegic refraction, procedure, date of surgery were noted. Postoperatively, the uncorrected visual acuity (UCVA), and date of follow up were noted. Four types of procedures were performed including PRK, LASEK, microkeratome assisted LASIK (LASIK), and intralase assisted LASIK (Intralase). Patient’s preoperative spherical equivalent (SE) determined their classification as hyperope (>0), low myope (0 to -2.99), moderate myope (-3.00 to -5.99), and high myope (<-6.00). Postop UCVA was followed and reported for all cases and compared per procedure and SE.
Results: :
The mean age of the 65 participants at the time of surgery was 36.0 years old, ranging from 20.3 to 60.3. 37 (57%) were male and 28 (43%) were female. Of the 130 eyes, 60 (46%) received LASIK refractive surgery and 66 (51%) of eyes received intralase. 2 (1.5%) eyes received PRK and 2 (1.5%) eyes had LASEK. Due to the small size, PRK and LASEK cases were excluded from subgroup analysis. Length of followup varied greatly, with a mean of 120 days, ranging from 1 to 587 days. The visits closest to 1, 7, 30, 90, 180 days postoperative were included for analysis. For all 130 eyes, the mean postop UCVA was 20/22. 79% of eyes had 20/20 vision. 98% had vision 20/40 or better. In regards to procedure type, the mean UCVA for LASIK (n=66) was 20/24.09 and 20/20.58 for Intralase (n=60). 80% of eyes with LASIK had 20/20 vision and 97% had vision within 20/40. Intralase had 80% cases within 20/20 and 100% within 20/40. No statistical difference existed in regards to UCVA and type of procedure (p= 0.9112). Per the SE groups, hyperopic eyes (n=6) had 83% within 20/20. Low myopes (n=39) had 77%. Moderate myopes (n=70) had 82%. High myopes (n=15) had 67%. No statistical difference existed in UCVA in respect to SE group (p=0.1805). As per complications; 2 slipped flaps, 3 DLK, 2 macro-striae- once addressed, all had 20/40 or better UCVA.
Conclusions: :
Resident performed refractive surgery can be safe and effective.
Keywords: refractive surgery • refractive surgery: LASIK • refractive surgery: optical quality