Eyeworld

EW FEATURE 54 The best way to gain expertise is first to find a mentor, Dr. Parkhurst said. He suggested visiting practices where a physician is willing to sit by your side and provide direct instruc- tion on how to perform various procedures and select the correct procedure for each patent. "Getting access to that kind of training goes beyond what you can access at a weekend training course or hear at a lecture," he said. It involves a hands- on, deep dive into the procedure. Dr. Parkhurst said there are a number of advanced training technologies, patients don't end up on refractive target, so laser vision correction is a handy tool. Corneal refractive surgery is proven to deliver high quality uncorrected vision, with a very low side effect profile, Dr. Yeu said. "If nothing else, refractive cataract sur- geons will have a skill set and option to help correct surprises from refrac- tive errors after cataract surgery." Before even getting into the top- ic, Dr. Parkhurst thinks it's import- ant to define what refractive surgery is. "The field is expanding with a lot of innovations and several recent [Food and Drug Administration] approvals," he said. In the past, Dr. Parkhurst said, refractive surgery was limited in definition to procedures like LASIK and PRK, but now encompasses additional procedures, some of which are applicable to the three milestones of human vision de- velopment. The first milestone, he said, is ocular maturity. This means that a child has completed physical growth, and the eye has stopped changing. This usually occurs between ages 18 and 20. Once that milestone has been reached, you can use a number of procedures, he said, like small incision lenticule ex- traction (SMILE, Carl Zeiss Meditec, Jena, Germany), LASIK, PRK, cross- linking, and phakic IOL implanta- tion to treat the distance vision in a permanent way. The second mile- stone, Dr. Parkhurst said, is presby- opia, and the third is cataracts. "Refractive surgery is expanding and becoming a subspecialty," he said. "While we think that every ophthalmologist should involve themselves in refractive surgery in some way, there are various ways to participate." He added that what's happening in refractive surgery is similar to other subspecialties, with expanding ways to perform surgery. Best ways to learn A skills transfer course could be helpful for surgeons wanting to learn the new technical skills needed for corneal refractive surgery, Dr. Yeu said. She recommended attend- ing a thorough didactic course and supplementing it with other didactic courses to understand some of the nuances involved with these sur- geries and how to manage potential complications. Surface ablation procedures are technically easier than LASIK, she added. With regard to learning this, Dr. Hatch thinks that a cornea and re- fractive fellowship is ideal. Learning laser vision correction is relatively straightforward for the anterior seg- ment surgeon, she said, but finding good candidates, treating the ocular surface, and having the ability to manage problems are key. "I think it's great if someone can start with a training program," she said. However, for those who have been out of training for many years and who are not necessarily going to do a corneal fellowship before doing laser vision correction, Dr. Hatch suggested taking a course and investing time with an experienced surgeon to learn as much as possible. Monthly Pulse Rebirth of laser vision correction T he topic of this Monthly Pulse survey was "Rebirth of laser vision correction." We asked, "Which of the following new refractive corneal procedures do you find the most exciting?" SMILE and topographic ablations were just about tied as the most popular answers, with advanced wavefront aberrometry ablations following closely behind. When asked about primary management of a patient with progressive keratoconus, the majority of respondents said they use riboflavin UV crosslinking and contact lens fitting. When asked, "What is your experience with LASIK?" more than half of respondents said they have been performing LASIK and plan on continuing. Finally, we asked, "How do you compare the patient experience with contact lenses to LASIK over the course of a lifetime?" Most responded, "LASIK is more comfortable and safer than contact lenses." Rebirth of laser vision correction • June 2017 LASIK procedure just after the flap is lifted, immediately preceding excimer laser ablation; in this example, the flap is centered upon the visual axis created by the VisuMax femtosecond laser, which is the same laser used to perform ReLEx SMILE. Source: Gregory Parkhurst, MD programs available, but he noted that there are only a handful of re- fractive surgery fellowships available in the U.S. today. Additionally, he said that many corneal fellowships are heavy in training for corneal pa- thology, transplants, and other cor- neal procedures, so refractive surgery training may need to be specifically sought out by the individual. A well- trained anterior segment surgeon has the skill set for some refractive procedures and would be well served by understanding all the options that are available. How to continued from page 52

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