Published in Refractive Surgery

The Resident’s Guide to Refractive Surgery Fellowship

Ji Hyae Lee, MD

Ji Hyae Lee, MD

Gregory D. Parkhurst, MD, FACS

Gregory D. Parkhurst, MD, FACS

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Learn how refractive surgery fellowships prepare residents for advanced surgical practice, with tips on what to expect and how to find the right program.

Image of a refractive surgery fellow performing surgery on a patient as a part of training.
Refractive surgery is widely practiced by many cataract and anterior-segment surgeons and continues to expand in scope; in this context, a fellowship in refractive surgery is increasingly relevant rather than representing a marginal niche. 1
Unlike cataract surgery, performing corneal refractive surgery is not an ACGME graduation requirement for US ophthalmology residents. As a result, most residents complete training with limited refractive surgery exposure.2
Historically, refractive surgery was considered a skill learned “on the job,” but with the increasing complexity of procedures and demand for consistent outcomes, it has evolved into a recognized subspecialty, complete with the opportunity to obtain official certification through the World College of Refractive Surgeons.

Overview of refractive surgery fellowships

Most refractive surgery fellowships are apprenticeship-style programs, often based in private practices, such as Parkhurst NuVision LASIK Eye Surgery - San Antonio, rather than academic centers.
In addition to surface procedures, such as LASIK and PRK, these programs often provide training in advanced technologies such as lenticular surgery, phakic intraocular lenses (IOLs), and premium lenses. Availability and competitiveness vary widely, and recruitment is often influenced by networking.
In recent years, an interest in “cataract fellowships” has merged with refractive training, reflecting the broader trend toward premium cataract and refractive lens-based solutions.3 With new technology and rising patient demand, refractive surgery is increasingly viewed as both an art and a discipline in its own right.
A career in refractive surgery offers a unique blend of cutting-edge technology, entrepreneurial practice models, and direct impact on patients’ quality of life.

To learn more about private practice fellowships, check out Starting a Private Practice Refractive Surgery Fellowship!

Why choose a refractive surgery fellowship?

Refractive surgery fellowships provide hands-on exposure to advanced procedures that are rarely emphasized in residency. While cataract training is universal, experience with LASIK, PRK, SMILE, ICL implantation, or refractive lens exchange is often very limited.
Fellowship training bridges this gap by offering surgical volume, mentorship, and practice-management insight. Beyond technical skills, refractive surgery is one of the few ophthalmology subspecialties where clinical and surgical mastery intersect with business acumen.4
Fellows learn how to approach pricing models, patient experience, management, and practice growth. For those drawn to innovation, patient satisfaction, and entrepreneurship, refractive surgery provides unparalleled career potential.

How to prepare during residency

For residents aspiring to include refractive surgery in their prospective careers, early preparation during training is key to building the skills, connections, and academic foundation that will shape future opportunities.

Core competencies

Prioritize strong fundamentals in cataract surgery: efficient phaco technique, astigmatism management, and precise pre-operative planning. These directly translate into refractive lens exchange and premium cataract cases.
Equally important is developing sound judgment in patient selection, which is critical in producing successful refractive outcomes. Residents should learn to identify ideal refractive surgery candidates and recognize relative contraindications, such as avoiding multifocal IOL implantation in patients with keratoconus or significant ocular surface disease.

Read more about refractive surgery for keratoconus patients in the article Refractive Surgery Options for Vision Correction in Keratoconus.

Mentorship

Seek mentors early. Even if your residency lacks refractive surgery faculty, connect with alumni, local surgeons, or industry leaders at meetings such as ASCRS, AECOS, CEDARS/ASPENS, Caribbean Eye, or Eyeprentice.
Young MD Connect and Real World Ophthalmology are valuable networks for meeting refractive surgeons and fellows. Mentorship is critical, especially in a niche field like refractive surgery.

Research

Consider research in refractive outcomes, IOL technology, or patient satisfaction. Presenting at ASCRS, AAO, or AECOS and publishing in journals signals commitment to the field and strengthens fellowship applications.

What to expect in a refractive surgery fellowship

Refractive surgery fellowship offers a comprehensive immersion into both the clinical decision-making and surgical skills required to manage complex cases and deliver individualized vision correction.

Lessons to learn

Expect to gain expertise in ocular surface optimization, keratoconus management, and post-refractive complications. Depending on the fellowship’s scope, exposure may also include cross-linking and advanced diagnostic interpretation. 
Fellows can expect to gain proficiency at ICL sizing and integrating multimodal imaging platforms such as iTrace into surgical planning.

Skills to master

Surgical training typically includes LASIK, PRK, SMILE, phakic IOL implantation, and premium cataract surgery with toric, multifocal, or light-adjustable lenses. Fellows also refine their skills in pre-operative diagnostics, patient selection, and counseling. These are critical to achieving consistent outcomes and patient satisfaction.
By graduation, fellows should be confident in performing a wide spectrum of vision correction procedures and be able to tailor refractive solutions to individual patient needs.

Looking for more direction on how to choose the right fellowship? Read What to Look For in a Refractive Surgery Fellowship for guidance!

Tips for success in a refractive surgery fellowship

  • Adopt a growth mindset: Refractive practices are fast-paced, and patient expectations are high. Stay adaptable.
  • Prioritize communication: Patient counseling is as important as surgical skill. Learn to explain risks, benefits, and realistic outcomes clearly but compassionately. It is important to be able to set expectations prior to surgery.
  • Be proactive: Show enthusiasm in the clinic and operating room. Maximize exposure to diagnostics like tomography, biometry, and UBM.
  • Track outcomes: Analyzing your surgical data and patient-reported results builds both credibility and confidence.
  • Engage with the community: Attend conferences, connect with industry, and establish an online presence.

Steps to finding your first refractive surgery position

Graduating from fellowship marks the beginning of your refractive career.
To secure your first position:
  • Leverage connections. Many fellows are recruited by their fellowship practices or through industry introductions.
  • Demonstrate versatility. Employers value surgeons comfortable with LASIK, SMILE, ICLs, and premium cataract surgery.
  • Differentiate yourself. Highlight unique expertise—such as experience with light-adjustable lenses, keratoconus, or cross-linking.
  • Understand business models. Private practices especially seek associates who contribute to patient experience, marketing, and overall growth. Comfort with the business management side sets you apart.

Closing thoughts

A refractive surgery fellowship is a launchpad into one of the most dynamic and entrepreneurial areas within ophthalmology. For residents who thrive on precision, innovation, and patient-centered care, refractive surgery blends artistry, technology, and leadership.
With the right preparation, mentorship, and fellowship experience, you’ll be ready to help define the future of ophthalmology.
  1. Srinivas SP, Young AL, Behndig A, et al. Controversies, consensuses, and guidelines on modern cataract surgery by the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO). Asia Pac J Ophthalmol. 2025;14(4):100224. doi:10.1016/j.apjo.2025.100224.
  2. Madu AA, Ali T. Resident laser refractive surgery training. Curr Opin Ophthalmol. 2010;21(4):265-268. doi:10.1097/ICU.0b013e32833a8967.
  3. Cummings AB. Refractive surgery training and fellowship opportunities. CRSToday Europe. March/April 2023. https://crstodayeurope.com/articles/mar-apr-2023/refractive-surgery-training-and-fellowship-opportunities/.
  4. Shafer BM, Yu AC, Busin M, et al. Educating the next generation of ophthalmologists: Insights into what works and what’s needed. Cataract & Refractive Surgery Today. June 2021. https://crstoday.com/articles/2021-june/educating-the-next-generation-of-ophthalmologists.
Ji Hyae Lee, MD
About Ji Hyae Lee, MD

Dr. Ji Hyae Lee is an ophthalmologist and a refractive surgery fellow at Parkhurst NuVision in San Antonio, Texas. Dr. Lee received her undergraduate degree from Dartmouth College, a Doctor of Medicine degree from Penn State University College of Medicine, and completed ophthalmology residency training at Saint Louis University.

Dr. Lee joined Parkhurst NuVision to train under Dr. Greg Parkhurst, focusing on refractive lens exchange, Light Adjustable Lens (LAL) technology, EVO ICL implantation, corneal refractive surgery, and complex cataract and anterior segment surgery. Passionate about innovation and patient experience, Dr. Lee has presented at international meetings and contributes to educational initiatives for ophthalmology trainees and early career surgeons.

More by Ji Hyae Lee, MD
Ji Hyae Lee, MD
Gregory D. Parkhurst, MD, FACS
About Gregory D. Parkhurst, MD, FACS

Dr. Gregory Parkhurst is a board-certified and fellowship-trained ophthalmologist and the chief surgeon at Parkhurst NuVision. Dr. Parkhurst graduated from medical school at Northwestern University. He then joined the US Army, rising to the rank of Major and accepting a residency at the Walter Reed Army Medical Center. He went on to complete fellowship training at both the University of Texas and the Slade & Baker Vision Center in Houston, receiving subspecialty training as a corneal specialist and refractive eye surgeon.

On the recommendation of colleagues, he founded Parkhurst NuVision, where he also serves as medical director. He has performed tens of thousands of eye surgeries and been recognized around the globe as a leader in a range of vision correction surgeries. His teaching, research, and his surgical experience has been widely publicized, and he’s had the honor of being invited to lecture important topics to renowned bodies in the world of eye surgery. Dr. Parkhurst’s career has always been dedicated to advancing the field of ophthalmology, and he looks forward to providing life-changing vision correction for many more patients in the future.

More by Gregory D. Parkhurst, MD, FACS
Gregory D. Parkhurst, MD, FACS
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