Refractive surgery certification varies between, within residency programs

Key Points

Boston-Results of a survey conducted to determine U.S. ophthalmology resident experience in refractive surgery reveals substantial variation across programs, said Joseph B. Ciolino, MD.

"However, we must remember that surgeon experience is only part of the education process," Dr. Ciolino said. "Many might argue that learning the elements of preoperative patient selection, proper planning, and postoperative management are more important than performing the surgery itself. These varying opinions and the results of our survey show this topic continues to be controversial."

The study was conducted in collaboration with Kundandeep Nagi, MD, and Robert L. Schultze, MD, when he was a resident at Albany Medical College, New York. He currently is a clinical cornea fellow at Massachusetts Eye and Ear Infirmary in Boston.

The investigators e-mailed an invitation to participate in a 17-item, online survey to all U.S. ophthalmology residency program directors; 26 directors (23%) responded, and they represented programs that were diverse with respect to geographic location and size (three to seven residents).

"One limitation of our study is its modest sample size and the possibility that the programs certifying residents in laser refractive surgery may have been more likely to respond," Dr. Ciolino said.

Certification was the outcome of primary interest and was accomplished if the resident completed a required certification class and performed at least one procedure as the primary surgeon. When considering their most recent graduating residency classes, survey participants indicated that a total of 117 residents were certified and had performed 305 procedures. Among the 26 programs, 58% had certified at least one resident, and 31% certified 100% of residents.

LASIK constituted more than one-half of the procedures performed (53%), and PRK accounted for the rest. Most residents had been certified with the VISX platform (83%).

Factors influencing certification

The survey also sought to elicit factors that possibly could limit a resident's ability to attain certification. Questions regarding faculty experience showed that programs certifying residents had a higher average number of faculty members performing laser refractive surgery compared with programs that did not certify residents: 3.8 versus 2.1, respectively.

"This finding was fairly intuitive, but surprisingly, we did not see a clear relationship between the volume of refractive surgery procedures performed by faculty members and resident certification. Some programs had faculty members who performed a high volume of refractive procedures and yet did not certify any residents," Dr. Ciolino said.

The programs that certified 100% of residents had more than double the amount of refractive surgery lecture hours than the noncertifiying programs. A difference also was found between the certifying and noncertifying programs with respect to whether the departments had a cornea fellow. Among the noncertifying programs, 60% had a cornea fellow, compared with 44% of programs that had residents certified in refractive surgery.

"This finding was expected considering that perhaps the cornea fellows were getting a lot of cases, and residents fewer-although the difference between the certifying programs and noncertifying programs is not that great," Dr. Ciolino said.

Results of questions characterizing laser access were surprising. Among the programs that had certified residents, only 47% had a laser owned by the university, whereas the rest used a laser at an outside facility.

"We were surprised by this because we expected that programs certifying residents would likely have a laser belonging to the university," Dr. Ciolino said.