Initial Resident Refractive Surgical Experience: Outcomes of PRK and LASIK for Myopia

Purpose: To evaluate and compare the outcome of initial resident surgical experience with photorefractive keratectomy (PRK) and LASIK. Methods: Retrospective review of all cases performed with the VISX Star S4 platform (Abbott Medical Optics) between July 1, 2003 and June 30, 2007. Inclusion criteria were spherical equivalent of −0.50 to −10.00 diopters (D), refractive astigmatic error of ≤3.00 D, intention to provide full distance correction, and minimum 3-month postoperative follow-up after initial ablation or retreatment (if performed). Results: A total of 153 cases performed by 20 different residents met the inclusion criteria; 38 eyes underwent PRK and 115 eyes had LASIK. After initial treatment, mean Snellen uncorrected distance visual acuity (UDVA) after PRK was 20/17.3 and after LASIK was 20/19.5. Photorefractive keratectomy was associated with a significantly better approximation between preoperative corrected distance visual acuity (CDVA) and postoperative UDVA (ΔlogMAR 0.009 vs 0.091; P =.004) and a greater percentage of eyes that achieved UDVA of 20/20 or better (94.7% vs 78.3%; P =.02) or 20/30 or better (100% vs 87.8%; P =.02). There was a higher prevalence of retreatment in eyes that underwent LASIK (7.0% vs 0%; P =.20). One (0.9%) eye lost 2 lines of CDVA after LASIK. Conclusions: Supervised refractive surgery residents can achieve excellent visual outcomes in patients operated during their initial refractive experience. Photorefractive keratectomy was associated with better visual outcome than LASIK.