Global health training in ophthalmology residency programs.

PURPOSE: To assess current global health education and international electives in ophthalmology residency programs and barriers to global health implementation in ophthalmology resident education. METHODS: A web-based survey regarding participation in global health and international electives was emailed to residency program directors at 116 accredited ophthalmology residency programs via an Association of University Professors in Ophthalmology (AUPO) residency program director listserv. RESULTS: Fifty-nine (51%) ophthalmology residency program directors responded. Thirty-seven program directors (63%) said global health was important to medical students when evaluating residency programs. Thirty-two program directors (55%) reported developing international electives. Reported barriers to resident participation in international electives were: 1) insufficient financial support, 2) inadequate resident coverage at home, and 3) lack of ACGME approval for international electives. Program directors requested more information about resident international electives, funding, and global ophthalmology educational resources. They requested ACGME recognition of international electives to facilitate resident participation. More than half (54%) of program directors supported international electives for residents. CONCLUSIONS: This survey demonstrates that program directors believe global health is an important consideration when medical students evaluate training programs. Despite perceived barriers to incorporating global health opportunities into residency training, program directors are interested in development of global health resources and plan to further develop global health opportunities.

Femtosecond laser will not be a standard method for cataract extraction ten years from now.

The femtosecond laser was recently introduced to cataract surgery in order to replace several highly successful and low risk manual surgical techniques with automated laser techniques. Despite the hope that femtosecond laser-assisted cataract surgery (FLACS) would lead to safer and more predictable surgical outcomes, the literature consistently demonstrates that FLACS has provided no advantage over standard phacoemulsification cataract surgery (SP). Yet, the disadvantages of FLACS as compared to SP are clear. FLACS is more expensive and time-consuming, may increase surgical complications during the surgeon's initial learning period, introduces unique risks due to the additional steps of laser docking and treatment, and is limited in its scope of use as compared to SP due to factors including small pupils and orbital anatomy. While FLACS may one day prove to be advantageous for a small subset of patients, such as those with corneal endothelial cell dysfunction or zonular instability, these patients have not been the targets of this technology, and FLACS will not become the standard technique for cataract extraction in the coming decade.

Enhanced effect of double-stacked intrastromal corneal ring segments in keratoconus.

We present a patient with poor visual acuity and contact lens intolerance due to advanced keratoconus who had femtosecond-assisted placement of two 0.35 mm intrastromal corneal ring segments (ICRS) in the right eye. Postoperatively, both rings migrated inferiorly and overlapped each other in a double-stacked formation. This resulted in a dramatic central shift of the cone and flattening of the inferior paracentral cornea with significant improvement in vision. To our knowledge, this is the first report of double-stacked ICRS in a human cornea and raises the possibility that significantly thicker segments may provide enhanced anatomic and visual effects in some keratoectatic patients.