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Cover Stories | Jun 2010


Tips for cataract surgeons on learning to perform this procedure.

This article draws upon my experience as a cataract surgeon who learned to perform LASIK. It shares the steps I characteristically follow when adding a new procedure to my practice. I hope the information is of help to cataract surgeons who wish to perform LASIK.

I learn and introduce a new procedure into my practice every 6 months. In the last 5 years, I have added the following to my surgical offerings: selective laser trabeculoplasty, Descemet’s stripping automated endothelial keratoplasty, deep stromal automated lamellar keratoplasty, endoscopic cyclophotocoagulation, presbyopiacorrecting IOLs, the Verisyse lens (Abbott Medical Optics Inc., Santa Ana, CA), the Visian ICL (STAAR Surgical Company, Monrovia, CA), Trabectome surgery (NeoMedix Corporation, Tustin, CA), and the Ex-Press mini glaucoma shunt (Alcon Laboratories, Inc., Fort Worth, TX). I visit several practices per year to see what my colleagues are doing, and they graciously share their experience and expertise. I do not abandon learning a procedure until I have faithfully performed a few, revisited the training surgeon, and subsequently completed a minimum of 20 procedures.

In 1984, I saw a 16-year-old Eagle Scout who had suffered a severe corneal ulcer from a contact lens that resulted in a significant loss of vision. It was only restored by a penetrating keratoplasty. I decided to perform RK to eliminate qualified patients’ need for contact lenses and avoid their complications. In 1992, I jumped at the chance to become an investigator of PRK for the FDA at Wills Eye Hospital in Philadelphia. That experience led me to learn all I could about the the technique and technology, which eventually led me to LASIK.

Adding LASIK to your offerings is reasonable if you have the grit and courage to evaluate, master, and perform the procedure. Make a plan for the transition and then follow it. Waiting until you have a dissatisfied patient with residual astigmatism is not the time to start the process. Think of a reasonably cooperative colleague who is not a direct competitor. It should be someone with whom you would be willing to share some of your expertise, a person who is open to assisting colleagues to learn new techniques. Salespeople who call on your prospective mentor may be able to give you an idea of how he or she might receive your request and how experienced he or she is. I find that the best approach is a personal call to talk with the person and ask if he or she is willing to help. If you are about to purchase or use a particular brand of excimer laser, then the manufacturer’s sales team can assist you in finding an appropriate mentor. It is in their interest for you to receive the best possible training.

I believe that any cataract surgeon has the observational and analytical skills to learn LASIK through observation alone. Additional help may be found in Internet resources and travel abroad. Often, the manufacturer of your excimer laser platform will have foreign sites where you may volunteer and gain hands-on experience. I have found that successful LASIK depends more on monitoring its steps than on surgical skill.

Again, I strongly recommend developing a system by which to introduce new procedures into your practice. Include your staff and administrators from the beginning of the process. Decide early on what surgical mix will work best in your hands and for your patient population. My own system can be broken into 12 steps.

No. 1. Take a Course
Attend meetings that discuss excimer laser ablation and that are attended by LASIK specialists. Talk to these surgeons during the breaks, make a dinner date, or arrange for a follow-up call while at the meeting.

No. 2. Talk to People
Contact sales people, your friends in ophthalmology, and administrators or friends of your administrator to get the lowdown on potential training opportunities. Ask them to introduce you to doctors who can share with you their experience and technique as well as their insight into the learning process. Call the surgeons and discuss on the phone the options for observation.

No. 3. Observe the Procedure Abroad
Consider international service or visits so that you can see how this procedure is performed elsewhere. You may wish to visit a relative neophyte, which can often be more instructive than watching a well-known LASIK surgeon who makes the procedure look easy. Sometimes, learning what not to do is more important.

No. 4. Involve Your Staff
Discuss the change you are planning with everyone in your practice. Get them involved in the process. Provide a free lunch to introduce LASIK to everyone on the staff. Ask them how they feel about your adding the procedure to the practice’s offerings. If the response is negative, think about your staff’s level of commitment and whether they are the right team (ie, one with whom you can make progress).

No. 5. Look for Possible Mentors
Visit several prospective doctors. You can always learn something before choosing the best environment in which to develop your skills.

No. 6. Have Fun
You will learn a great deal about ophthalmology as well as LASIK from your colleagues.

No. 7. Prepare Your Staff
Train your technical staff on how to talk to patients about LASIK. Select or hire a refractive coordinator to educate and monitor your LASIK patients.

No. 8. Identify Your Target
Figure out which of your current patients might benefit from LASIK.

No. 9. Plan a Field Trip
Take key people on your staff with you to visit a practice that you want yours to emulate.

No. 10. Rehearse
Run through the steps of the entire LASIK process several days before you begin to offer the procedure. The goal is to ensure that you have all of the right equipment and to allow time for your associates to pose questions and develop their model of care. If you operate in an ambulatory surgery center, schedule an in-service day before your first official day of performing LASIK and do the aforementioned run-through so that everyone has some familiarity with the procedure.

No. 11. Make the Effort
Schedule several patients for LASIK on the first day you begin offering the procedure. Make sure to have all of the technical assistance you can get. Do not give up until you have operated on 20 eyes and call your colleagues with any questions or concerns. My advice is to call early and call often.

No. 12. Be Open
Remember to share your experience with your colleagues. They will benefit, and so will you from the review and the exchange of information and tips not available in textbooks and articles on LASIK. The real nuances of a surgical procedure are still best learned in a doctor-to-doctor environment.

Steven B. Siepser, MD, is the medical director of Siepser Laser Eyecare in King of Prussia, Pennsylvania. He acknowledged no financial interest in the products or companies mentioned herein. Dr. Siepser may be reached at (888) 859-2020; ssiepser@siepservision.com.

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