Abstract
Abstract: :
Purpose:To compare the outcomes of laser in situ keratomileusis (LASIK) performed by residents and fellows with those of cornea trained faculty members at an academic ophthalmology training program. Methods: A retrospective cohort study was conducted of all myopic LASIK cases performed by residents or fellows (trainees) between 1/1/99 and1/15/04 at the University of California, San Francisco. Cases performed by trainees were compared with age–matched and preoperative spherical equivalent–matched faculty–performed cases. The primary endpoint was the percent of eyes achieving uncorrected visual acuity (UCVA) of 20/25 or better at 1 month. Secondary endpoints were percent of eyes achieving UCVA of 20/20 or better, percent of eyes attaining UCVA of 20/40 or better, postoperative refractive error, complication rates, enhancement/reoperation rates, and percent of eyes losing 1 or more lines of BSCVA. Results: A total of 124 trainee and 108 faculty cases were identified. Trainee and faculty cases were comparable in age, sex, mean age, mean follow–up, and baseline refractive error. At 1 month follow–up, UCVA of 20/25 or better was achieved in 71% of trainee and 79% of faculty cases (p=0.02), UCVA 20/20 or better attained in 50% of trainee and 65% of faculty cases (p=0.01), and UCVA 20/40 or better achieved in 91% of trainee and 94% of faculty cases (p=0.12). Residual refractive error was similar between groups. The incidence of microkeratome complications and any observable epithelial ingrowth, diffuse lamellar keratitis, or microstriae, regardless of clinical severity, was 36% in trainee vs. 27% in faculty cases (p = 0.02), but severe complications (microkeratome–related and those requiring refloat) occurred only in trainee cases (4% vs. 0% in faculty cases). Enhancement/reoperation was performed in 16% of trainee and 10% of faculty cases (p<0.01). One–line loss of BSCVA occurred in 7% of trainee and 9% of faculty cases (NS); neither group lost 2 or more lines of BSCVA. Conclusions: Patients undergoing LASIK by a resident or fellow were less likely to achieve 20/20 or 20/25 UCVA, more likely to experience postoperative complications, and more likely to require enhancement/reoperation when compared to cases performed by fellowship–trained faculty. Residual refractive error and frequency of loss of BSCVA was comparable between the groups. Patients should be appropriately counseled on the outcomes of LASIK performed by trainees.
Keywords: refractive surgery: comparative studies • refractive surgery: complications • refractive surgery: LASIK