Learning New Surgical Techniques Through Mentorship

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9 min read

Discover pearls for mentorship opportunities for trainees and ophthalmologists who want to specialize in refractive surgery.

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.

Interventional Mindset is an educational series that gives eye physicians the needed knowledge, edge, and confidence in mastering new technology to grow their practices and provide the highest level of patient care. Our focus is to reduce frustrations associated with adopting new technology by building confidence in your skills to drive transformation.

Browse through our videos on a variety of topics within cataract and refractive surgery, glaucoma, and ocular surface disease to learn practical insights into adopting a variety of new surgical techniques and technology.

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:
  1. 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.
  2. 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.
Nandini Venkateswaran, MD
About Nandini Venkateswaran, MD

Dr. Nandini Venkateswaran is a member of the Cornea and Refractive Surgery Service at the Massachusetts Eye and Ear Infirmary and an Instructor of Ophthalmology at Harvard Medical School. She is a fellowship-trained cataract, cornea and refractive surgeon. Dr. Venkateswaran earned her medical degree with a distinction in community health from the University of Rochester School of Medicine and Dentistry, where she was inducted into the Alpha Omega Alpha medical honor society. She completed her Ophthalmology residency at the Bascom Palmer Eye Institute/University of Miami, after which she completed a fellowship in cornea, external disease and refractive surgery at Duke University.

Dr. Venkateswaran truly enjoys employing her clinical and surgical expertise and research background to treat patients with a compassionate, customized and multidisciplinary approach. She specializes in complex cataract surgery, femtosecond laser assisted cataract surgery with intraoperative aberrometry, most advanced techniques in corneal transplantation (DMEK, DSAEK, DALK, PKP), laser refractive surgery (LASIK and PRK), corneal cross-linking, anterior segment reconstruction (including secondary IOL implantation and iris repair), dry eye disease and ocular surface lesions and tumors.

Dr. Venkateswaran is an active member of the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery and currently serves on several committees in these organizations. She has co-authored over 40 peer-reviewed publications and numerous book chapters early in her career. She has received several awards for her excellence in research and clinical care and has presented her scientific work at numerous national and international meetings.

Outside of work, Dr. Venkateswaran enjoys spending time with her friends and family, learning to cook, and riding her peloton bike.

Nandini Venkateswaran, MD
Arjan Hura, MD
About Arjan Hura, MD

Dr. Arjan Hura is a cataract, refractive, and anterior segment surgeon at the Maloney-Shamie Vision Institute in Los Angeles, CA. Dr. Hura is passionate about providing his patients with the highest possible medical and surgical vision care and is committed to the American Academy of Ophthalmology‘s mission of protecting sight and empowering lives. His research and clinical interests include working with the latest cutting-edge technology to constantly try to improve patient outcomes.

Prior to joining MSVI, Dr. Hura completed his fellowship at the Cleveland Eye Clinic where he performed the full spectrum of vision correction, including advanced lens laser cataract surgery, laser vision correction through LASIK, PRK, and SMILE, implantable contact lenses, corneal cross-linking, and MIGS surgery.

During his residency at the University of Cincinnati, Dr. Hura was involved in several award-winning research studies and investigator-initiated trials. He received a National Eye Institute grant to present at ARVO during his internship, and he presented at ASCRS during all three years of his ophthalmology residency and was awarded Best Paper of Session at ASCRS 2019.

Arjan Hura, MD
Brett Mueller II, DO, PhD, PCEO
About Brett Mueller II, DO, PhD, PCEO

Brett H. Mueller II, DO, PhD, PCEO is a board-certified and fellowship-trained ophthalmologist who specializes in and has performed thousands of cataract and refractive eye surgeries. With advanced fellowship training in refractive surgery through the world college of refractive surgery and visual sciences, he hones a comprehensive range of skill sets needed to diagnose, address, and treat the full spectrum of refractive surgery.

After receiving his undergraduate degree from Texas A&M University, he then received his medical degree and PhD from the University of North Texas Health Science Center. His scientific work and academic accomplishments enabled him to author over 45 publications and book chapters, present at national and international meetings, and be a recipient of several grants (including an NIH grant). He was then accepted to attend an ophthalmology residency at the University of Louisville, where he developed a reputation for being a leader amongst his colleagues, serving as chief resident, and a skilled surgeon. After finishing residency training, Dr. Mueller then completed a one-year refractive, cataract, and anterior segment fellowship through the Refractive Fellowship Network and the World College of Refractive Surgery and Visual Sciences. He now specializes in state-of-the-art laser-guided cataract surgery and advanced lens implants that reduce or eliminate the need for glasses. He also specializes in the full spectrum of refractive surgery, which includes: modern LASIK, SMILE, EVO-ICLs, Refractive Lens Exchange, PRK, and Cross-Linking.

Brett Mueller II, DO, PhD, PCEO
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