Transitioning from mechanical microkeratome to femtosecond laser flap creation: visual outcomes of an experienced and a novice LASIK surgeon.

PURPOSE: To compare the visual outcomes of the first 200 myopic laser in situ keratomileusis (LASIK) cases between a mechanical microkeratome expert surgeon and a fellowship-trained surgeon transitioning to the femtosecond laser.

SETTING

London Vision Clinic, London, United Kingdom.

DESIGN

Comparative case series.

METHODS

This analysis comprised the first 200 consecutive myopic LASIK procedures using the Visumax femtosecond laser and the MEL 80 excimer laser for an expert surgeon (11,637 previous microkeratome LASIK procedures) and a fellowship-trained surgeon (observed 1057, performed 155 supervised LASIK procedures) following a standardized surgical technique. Inclusion criteria were preoperative spherical equivalent (SE) refraction up to -8.50 diopters (D), cylinder up to 3.50 D, and corrected distance visual acuity (CDVA) of 20/20 or better. Follow-up was 1 year.

RESULTS

There were no statistically significant differences in outcome measures between surgeons. Preoperatively, the mean SE was -4.00 D ± 1.83 (SD) and -3.97 ± 1.98 D and the mean cylinder was 0.81 ± 0.67 D and 0.79 ± 0.66 D for the expert surgeon and fellowship-trained surgeon, respectively. Postoperatively, the SE was ±0.50 D in 79% and 74%, uncorrected distance visual acuity was 20/20 or better in 96% and 96%, and 1 line of CDVA was lost in 3.5% and 1.5% for the expert surgeon and fellowship-trained surgeon, respectively. Contrast sensitivity increased or was unchanged.

CONCLUSION

A fellowship-training program based on a standardized surgical protocol resulted in statistically comparable outcomes between an expert surgeon and a fellowship-trained surgeon when newly transitioned to a femtosecond laser device.