In this episode of Interventional Mindset, Nandini Venkateswaran, MD, Brett Mueller II, DO, PhD, PCEO, and Arjan Hura, MD, discuss the value of mentorship for residents, fellows, and practicing ophthalmologists when learning new refractive surgery techniques and technologies.
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Seeking out a refractive surgery mentor
Dr. Venkateswaran noted that as refractive surgeons, it’s valuable to be able to offer patients a variety of options, and it’s up to surgeons to use their expertise to match the right procedure with the patient’s vision goals.
When starting the journey to finding a refractive surgery mentor, Dr. Hura recommended that surgeons identify the potential resources they have access to based on what stage of their career they are in. He pointed out that the majority of residents leave their programs as comprehensive ophthalmologists, and if they’re interested in refractive surgery, the traditional path has been to do academic cornea or cornea and refractive hybrid fellowships in the hopes of getting refractive surgery training.
Private practice refractive surgery fellowships
However, if someone wants dedicated refractive and cataract surgery training, there are high-volume private practice fellowships that exist that focus exclusively on refractive surgery and often expose the fellow to the entire spectrum of refractive surgery procedures, technology, clinical trials, and industry collaboration, as well as give insight into how to run a successful practice, all under the committed guidance of a mentor.
These refractive surgery fellows often graduate with thousands of repetitions of both cornea and lens-based refractive surgery procedures and thus feel confident in their ability to perform refractive surgery right out of training.
To underline this, Dr. Mueller highlighted that he left training as a comprehensive ophthalmologist, and unfortunately, during this residency, he wasn’t exposed to many of the different facets of refractive surgery. Eventually, he realized that trying to learn the techniques without a proper infrastructure in place would have taken him years, so he decided to apply for a private practice refractive surgery fellowship.
There, he learned every refractive procedure available, and it gave him the opportunity to be exposed to new technologies and practice them under the guidance of a mentor to refine his skills and ultimately build his confidence.
Understanding the differences between refractive surgery fellowship programs
While refractive and cataract fellowships have existed for many years, Dr. Hura remarked that this path isn’t often discussed during residency. For practicing comprehensive ophthalmologists interested in refractive surgery, he underlined that it is crucial to find a mentor who you trust will be dedicated and committed to teaching you.
Dr. Hura also noted that although refractive surgery has a very high success rate with positive outcomes and great patient satisfaction, managing complications requires skill, knowledge, and experience, all of which require exposure to volume. Complications in refractive surgery are rare, so it may take hundreds or thousands of cases before a beginning refractive surgeon may experience a complication.
Achieving this refractive surgery volume as a comprehensive ophthalmologist, even under the guidance of a mentor, may take many years. A dedicated refractive surgery fellowship allows surgeons to access high-volume surgical practices, which can greatly speed up the timeline and expose surgeons to a whole spectrum of patients and anatomy.
Academic cornea and cataract refractive fellowship programs
Further, Dr. Venkateswaran noted that she completed an academic cornea and cataract refractive fellowship, and her experience was different from a private practice refractive surgery fellowship. Her academic program wasn’t a high-volume refractive practice: instead, the focus was on identifying and recruiting the right patients, understanding the appropriate work-up, and listening to how surgeons counsel patients on different treatment options.
During her fellowship, Dr. Venkateswaran used to take note of how different surgeons discussed lasik in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE) with patients. Based on her observations, she picked up various pearls for effectively communicating the plethora of options for refractive surgeries to patients.
She noted that the surgical technique involved in refractive procedures, in general, can be easy to learn, but gaining the expertise to effectively identify and counsel patients, communicate treatment expectations, and ultimately choose the best refractive procedure that aligns with their vision goals is what will help surgeons success and empower patients to make well-informed decisions.
Identifying the “right” mentor
When discussing the value of finding a mentor who you connect with, Dr. Mueller observed that it can be difficult for ophthalmologists to find a mentor that matches their specific interests because the world of refractive surgery can be so broad, and is considered by some to still be like the Wild West. He added that it’s critical for surgeons to find a good mentor to avoid picking up surgical habits that can lead to bad treatment outcomes and dissatisfied patients.
Further emphasizing this point, Dr. Hura underlined the importance of understanding and having access to the entire spectrum of refractive surgery, as someone who doesn’t know or practice the entire spectrum of refractive surgery might have a limited capacity to choose the right procedure for a given patient, which can lead to suboptimal outcomes. Patients are electing to undergo elective cash-pay procedures to improve their vision, so it’s critical that surgeons select a procedure that will result in the desired outcome.
Pearls for finding a refractive surgery mentor
To broaden the knowledge base and exposure to refractive surgery, Dr. Mueller offered that surgeons could look for more than one mentor. This way, surgeons can compare the same techniques between individuals and witness as many technologies and techniques as possible. Similarly, maintaining relationships with other ophthalmologists by communicating with them about questions related to treatments, or getting a second opinion, is an organic approach to connecting with other surgeons and strengthening your own understanding of refractive surgery techniques.
When looking for a mentor, Dr. Hura highlighted two general approaches:
- Email or call surgeons at private practices who perform the procedures you wish to learn. There are many surgeons willing to take someone under their wing and spend a few days with them to observe how they do surgery and communicate with patients.
- Attend conferences and events where you can meet and build relationships with other surgeons from across the country. The world of ophthalmology, especially refractive surgery, is very friendly as everyone wants to collaborate and work towards improving patient outcomes.
Dr. Hura also advised medical students without a home ophthalmology department who are trying to figure out how to find a mentor, to go to conferences, as networking will increase the chances of being exposed to ophthalmologists who can potentially guide them on their journey to ophthalmology.
Further, he highlighted the value of social media, as many ophthalmologists interested in teaching have a social media presence. Additional resources, such as podcasts (like Interventional Mindset), YouTube videos, and webinars, offer trainees many opportunities to seek out mentors who specialize in any area of interest.
Final thoughts
Dr. Venkateswaran concluded that many refractive surgeons enjoy sharing their clinical and surgical pearls because they love what they do and find it gratifying.
While seeking out a mentor and mentorship opportunities may seem difficult, with enough motivation, there are resources available to trainees and ophthalmologists to facilitate the process and zero in on which refractive surgery techniques they want to hone.
