Complications and Visual Outcome of LASIK Performed by Anterior Segment Fellows vs Experienced Faculty Supervisors

Purpose

To determine the complication rates and visual outcome of laser-assisted in situ keratomileusis (LASIK) that is performed by anterior segment fellows and to compare their results with the results of their experienced faculty supervisors.

Design

A single-center, retrospective, interventional, nonrandomized, comparative case series.

Methods

Chart review of the initial 50 LASIK procedures that were performed by each of 10 anterior segment fellows and the first 50 inclusion criteria-matched, contemporaneously performed cases of four faculty members at the King Khaled Eye Specialist Hospital between March and December 2003.

Results

There were no statistically significant differences between fellow and faculty cases with respect to complication rates and final visual outcomes. The fellows were significantly more likely to experience microkeratome-related flap complications during their first 25 cases, compared with their second 25 cases (4.8% vs 1.2%; P = .03). Fellows were significantly more likely to perform enhancements (8.0% vs 2.0%; P = .0002), after which the eyes in their group were more likely to be within 1 diopter of the intended refractive target than those in the faculty group (96.0% vs 91.0%; P = .01). Although not statistically significant, eyes in the fellow group were four-fold (2.0% vs 0.5%) more likely to lose two or more lines of best spectacle corrected visual acuity than those in the faculty group.

Conclusion

To minimize the adverse impact of complications during the learning curve of novice LASIK surgeons, the introduction of this procedure in a well-structured, supervised setting (such as a subspecialty fellowship training program) is recommended.