is fellowship required to become a lasik machine?

Originally posted by chef
lol, just wondering if fellowship is required to do lasiks.

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More and more residency programs are training ophthalmologists to do refractive surgery. Some enhance their skills and learn new techniques from courses. So, the answer to your question is no.

However, I would not recommend getting refractive surgery from anyone else except from a fellowship trained physician with an excellent reputation. Being in an academic referral center, I see the numerous complications after refractive surgery from the outside; thus, I would only recommend getting it done by someone who really knows what they're doing.

Ophtho_MudPhud:

Just curious...

Do you think that you may have a selection bias? For instance, during my Peds rotation I saw 2 patients with Addison's. The parents of the kids, needless to say, were VERY upset with their primary Peds docs, and in the end, ended up firing their PCP - as no "good doctor" would have missed the diagnosis. Needless to say, their presentation was quite enigmatic, and with the incidence rate of Addison's, one could argue that more prevalent diseases were far more likely to be responsible for their presentations....

Regardless, while I agree that one should always go to the most qualified physician for procedures (especially when eyesight is involved), I wonder if what you may be observing in your current academic-based practice may be a bit narrow and really involve procedures that have gone wrong...

Regards,

Airborne

Originally posted by Airborne
Ophtho_MudPhud:

Just curious...

Do you think that you may have a selection bias? For instance, during my Peds rotation I saw 2 patients with Addison's. The parents of the kids, needless to say, were VERY upset with their primary Peds docs, and in the end, ended up firing their PCP - as no "good doctor" would have missed the diagnosis. Needless to say, their presentation was quite enigmatic, and with the incidence rate of Addison's, one could argue that more prevalent diseases were far more likely to be responsible for their presentations....

Regardless, while I agree that one should always go to the most qualified physician for procedures (especially when eyesight is involved), I wonder if what you may be observing in your current academic-based practice may be a bit narrow and really involve procedures that have gone wrong...

Regards,

Airborne

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Airborne,

I agree with you that I am more cautious because I'm in an academic setting. But I think caution is good when it comes to patient care. The great physicians I've learned from never forget this caution. One of my ophthalmology attendings have always emphasized the following when formulating a differential diagnosis: think about what is the worst possible diagnosis and think about the most common diagnosis. There are several diagnoses in this field that will either kill or result in the loss of vision if missed.

The example you gave above is a rare and difficult case. I think firing the PCP is a bit extreme. Rare diseases are tough to diagnose and may be missed. I would never advocate taking children to only see specialists. This is not cost effective nor is it good medical care.

However, when surgery is involved, I would want the most experienced surgeons for myself. Therefore, in regards to refractive surgery, I would recommend a corneal specialist. This said, I would also recommend a general ophthalmologist who has had extensive experience. Whether I am in an academic setting or private practice, I will always take surgery seriously and cautiously.

Andrew,

Just a question from a casual observer (& satisfied LASIK customer in 1999). Having had this done and having paid a little attention to some of the advances in technology since I've had it done. It seems to me that in fact very little surgical skill is needed to do LASIK procedures with the latest imaging software & that raising the corneal flap is pretty simple. Do I have the wrong impression of all this?

droliver,

You're correct. Lasik is a fairly simple surgical procedure. The most difficult part is making the flap with the microkeratome.

The reason why I prefer experienced surgeons is that the evaluation for surgery and the management of possible bad outcomes is better done by an experienced physician. For instance, there's a current lawsuit against an OD and MD who co-manage LASIK patients. The OD had a patient who had some astigmatism, and the patient had mutiple corneal topography scans. The patient had mild marginal pellucid degeneration, which was overlooked by both parties. The OD sent the patient to the MD for LASIK surgery without the corneal topography maps. The MD did not bother to do a scan before the surgery. LASIK was performed resulting in excessive thinning of the cornea and precipitous drop in vision. The patient will likely need a cornea transplant now.

When any surgery is done, this is why I strongly advocate for those with the proper training and experience. LASIK on thin corneas, early keratoconus, pellucid degeneration, previous keratitis (e.g. HSV), and many other disorders could result in devastating outcomes. In addition, there are post surgical complications that need to be recognized early to reduce visual loss. I believe that fellowship trained corneal surgeons and ophthalmologists who have extensive experience with refractive surgery are better prepared to recognize diseases that may result in poor outcomes.

Proper training and experience are both required to know when to cut and not to cut. This is just as important, if not more than, knowing how to do the surgery.