Eyeworld

16 March 2019 EW NEWS & OPINION by Ellen Stodola EyeWorld Senior Staff Writer/Digital Editor such as torics, multifocals, and EDOFs. Corneal relaxing incisions in training About one-third of fellows and those who have been in practice less than 5 years indicated that they did not perform manual corneal relaxing in- cisions in training (and 67% of those in years 1–3 of training have not). Dr. Lee finds these results inter- esting and said that he thinks this is a significant number of physicians who are not performing corneal relaxing incisions. At his practice, Dr. Lee uses manual or laser-assisted relaxing incisions in about 40% of his cases. "It's standard of care in my mind to do something to address the corneal astigmatism," he said. Dr. Zavodni said he finds it surprising that roughly a third of young surgeons have not performed corneal relaxing incisions. "Aside from being technically easy and low risk, LRI/AKs are an essential technique for any refractive cataract surgeon managing low amounts of regular astigmatism," he said. "These data suggest to me that there are still a minority of providers who are not greatly concerned with the refractive outcome of their surgery." Dr. Kim thinks this is less sur- prising because in her experience, although she did learn how to create manual limbal relaxing incisions, she doesn't find herself using them very often. "I don't think this is an issue, though, because most visually significant astigmatism can be cor- rected with a toric IOL," she said. Toric IOL implantation Based on the survey data relating to toric IOLs, 46% of physicians with 1–3 years of training have not performed toric IOL implantation (with the average of this group being nine toric cases). Meanwhile, 21% of fellows have not performed toric implantation (with the average of 17 cases), and 7% of those in practice less than 5 years have not performed toric implantation (though the average number of toric cases in this group is 32). At first glance, the toric IOL data seem fairly reasonable, Dr. Zavodni said. "More than 90% of providers in their first 5 years of practice have used toric lenses, and more than 90% of these same providers are YES connect Several data points in the 2018 survey identify young physicians' experiences with corneal relaxing incisions, toric IOLs, and other lenses T he 2018 ASCRS Clinical Sur- vey included a number of data points relating specif- ically to young physicians, including those in their first 1–3 years of training, fellows, and those in practice less than 5 years. Zachary Zavodni, MD, Salt Lake City, Joan Kim, MD, Skokie, Illinois, and Samuel Lee, MD, Sacramento, California, commented on some of the data related to experience with corneal relaxing incisions and lenses ASCRS Clinical Survey results highlight key issues for young physicians T he 2018 ASCRS Clinical Survey addressed the experiences of young eye surgeons with refractive cataract surgery. The results are separated by train- ees in years 1–3 of training, fellows, and physicians in practice for less than 5 years. Topics included corneal relaxing incisions, toric lens implantation, and managing the unhappy premium IOL patient. In this month's "YES connect" column, Zachary Zavodni, MD, Samuel Lee, MD, and Joan Kim, MD, review some of the results from the 2018 ASCRS Clinical Survey, which showed a lack of experience for many trainees and young physicians, leading to a lack of confidence in managing unhappy patients. Lenses are rapidly developing and changing, so the physicians in practice and those teaching current trainees may have experience with prior generations of lenses, leading to more complaints and making them hesitant to try the newer options. It is important for trainees and young surgeons to be able to work with teachers who can expose them to these technologies so that they can learn the advantages and pitfalls. This will help them develop the confidence to use these technologies in their patients. It will also expose them to the unhappy patient in a setting where they can learn how others deal with the issues that come up. David Crandall, MD, YES connect co-editor The survey asked, "How confident are you in the postoperative management of an unhappy toric IOL patient?" 1–3 years of training: 21% Very Confident or Confident; fellow: 36%; <5 years in practice: 55% The survey asked, "How confident are you in the postoperative management of an unhappy presbyopia-correcting IOL patient?" 1–3 years in training: 19% Very Confident or Confident; fellow: 32%; <5 years in practice: 37% Source (all): ASCRS Clinical Survey The survey asked, "During your training, how many manual corneal relaxing incisions have you performed (AK, LRI/PCRI)?" 1–3 years in training: 67% have not performed any; fellow: 29% have not performed any; <5 years in practice: 34% have not performed any continued on page 18 either 'confident' or 'very confident' in preop and implantation tech- niques," he said. He added that though the resi- dent group may be lacking in con- fidence with toric IOLs, this metric improves greatly once surgeons gain early experience. Dr. Lee said that in his practice, about 20% of his cataract surgeries include toric lenses. "If you're ex- posed to this technology, it's easy to pick up and can be used for a large percentage of patients," he said. Additional survey data identifies young physicians' experience with multifocal and EDOF IOLs. For those with 1–3 years of training, 75% had

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