Eyeworld

46 | EYEWORLD | JANUARY/FEBRUARY 2020 R YES CONNECT EFRACTIVE by Liz Hillman Editorial Co-Director R esident exposure to laser vision cor- rection is a nuanced topic. Residents might wish for more hands-on train- ing, but as an elective, out-of-pocket procedure, patients are more likely to choose a surgeon already in practice. There is also no standard among residency programs for how much exposure to laser vision correction—observed or hands- on—that residents receive. As such, it's not surprising to Charles Flowers, MD, or Ronald Krueger, MD, that 38.8% of YES members who responded to the 2019 ASCRS Clinical Survey said they were confident or very confident with this type of refractive surgery. Non-U.S. YES respondents were more confident (45.8%) compared to their U.S. counterparts (33.3%). The majority of U.S. residents, fellows, and surgeons within their first 5 years of practice had only observed cases (33%). "I think residency programs have not, historically, trained their residents in refractive surgery," Dr. Krueger said. "Now there is an ACGME [Accreditation Council for Graduate Medical Education] mandate that every resident participate or see 10 cases in order to have their residency qualifications met." But is that enough? "It's still very minimal," Dr. Krueger said. According to Drs. Krueger and Flowers, residency training programs are not standard- ized across the board in how they expose resi- dents to refractive surgery/laser vision correc- tion. Programs are also figuring out how best to incorporate laser refractive surgery into training. "Most of the older generation had the philosophy that you should never operate on a 20/20 eye. Someone correctable to 20/20 should be perfectly happy with glasses or con- tact lenses. That's the old view of a generation or more ago," Dr. Krueger said. "As things have progressed and refractive surgery has hit the mainstream of ophthalmology and has a signif- icant involvement in many practices around the country, there is more realization that it is here to stay. There is still some of that old guard Insights on young eye surgeons' exposure to laser vision correction About the doctors Charles Flowers Jr., MD Associate professor of clinical ophthalmology USC Roski Eye Institute Keck School of Medicine University of Southern California Los Angeles, California Ronald Krueger, MD Director Stanley M. Truhlsen Eye Institute University of Nebraska Medical Center Omaha, Nebraska The 2019 ASCRS Clinical Survey asked, "Given your training and/or other experience you have received thus far, how would you rate your confidence with laser vision correction?" Source: ASCRS 38.8% of respondents confident or very confident with laser vision correction In the 2019 ASCRS Clinical Survey, ophthalmologists in residency, fellowship, or their first 5 years of practice were asked to rate their comfort with and exposure to a number of surgical procedures. While Young Eye Sur- geons (YES) members continue to report increasing con- fidence with toric and presbyopia-correcting intraocular lenses, there was a surprise in the survey. It revealed a new low—only one-third of U.S.-based YES members stated that they were confident performing laser vision correction or had personally performed LASIK, PRK or SMILE. With the perennial popularity of laser corneal refractive surgery, it is surprising that our U.S.- based residents have such little exposure in residency. Although many residents will not go on to perform refractive surgery in their careers, understanding the indications, safety, and technical aspects of laser vision correction procedures is a critical part of a comprehen- sive ophthalmic education. The 2019 ASCRS Clinical Survey results show that we are failing our residents in this aspect. Laser vision correction education should not be an optional part of residency, and we owe our residents a better experience. This month, we asked two academic refractive surgeons to share how they handle the integration of surgical refractive care in a teaching setting. Following their advice would be a start toward a better resident experience in corneal refractive surgery. Julie Schallhorn, MD YES Connect Co-Editor Very confident Confident Neutral Unconfident Not confident at all

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