Ophthalmic Education:

International Curriculum Guidelines on Medical Student Education in Ophthalmology: 8. Refractive Surgery***

On this page:

• i) Types of refractive errors*
  
  
• ii) Types of surgical techniques to correct refractive errors***
  
  
• iii) Recent advances involve the use of FDA approved excimer laser to perform***
  
  
• iv) Effectiveness of refractive surgery***
  
  
• v) Risks associated with refractive surgery include***
  
  
• vi) Success in refractive surgery depends on***
  
  
• Competencies
  
  
• Educational Priorities

The International Council of Ophthalmology Task Force on Medical Student Education in Ophthalmology

Draft, September 16, 2003

I. Types of refractive errors:*

1. Myopia ? long eye or steep cornea
   
2. Hyperopia ? short eye or flat cornea
   
3. Astigmatism ? uneven curvature of cornea
4. Presbyopia ? inability to focus at near due to aging

II. Types of surgical techniques to correct refractive errors:***

1. Incisional ? weaken cornea structurally to induce changes in its curvature
   
2. Lamellar ? change shape of the cornea with addition or removal of tissue
   
3. Thermal ? shrink corneal collagen to induce corneal steepening
   
4. Intraocular ? implantation of intraocular lens or removal of crystalline lens

III. Recent advances involve the use of FDA approved excimer laser to perform:***

1. Photorefractive keratectomy (PRK)
   
2. Laser in situ keratomileusis (LASIK)

IV. Effectiveness of refractive surgery:***

1. Continues to improve
   
2. Newer techniques such as LASIK are more predictable than older techniques such as RK
   
3. Uncorrected visual acuity of 20/40 or better is achieved in 95% of eyes after myopic LASIK in most large series
   
4. Range of treatable refractive errors is expanding

V. Risks associated with refractive surgery include:***

1. Infection
   
2. Loss of best-corrected visual acuity
   
3. Overcorrection, undercorrection, regression
   
4. Visual aberrations such as glare and halos

VI. Success in refractive surgery depends on:***

1. Careful preoperative evaluation
   
2. Exclusion of systemic diseases and eye disorders that may be contraindicated
   
3. A thorough explanation of treatment options and risks and benefits of each procedure

Competencies

• Student should
  • Understand refractive errors and their relations to eye length, corneal curvature, and lens status.*
    
  • Describe refractive surgical theory and practice.***
    
  • Understand risks and benefits of commonly discussed and performed refractive procedures.***

Educational Priorities

In the listing above, essential ophthalmic knowledge and clinical eye care skills are marked with a single asterisk *. This material is basic for all international medical student education.

Information that reflects a greater level of understanding is marked with two asterisks**.

Areas of cognitive and clinical skills that are more appropriate for students who seek further training in ophthalmology are marked with three asterisks***.

While important to ophthalmic care, the Task Force does not regard the cognitive or skill set designated ** or *** as essential to the basic curriculum of most international medical students.

Next: 9. Ocular Manifestations of Systemic Disease

Also see:

• Introduction to the "International Curriculum Guidelines on Medical Student Education in Ophthalmology"
  
  
• Table of Contents for the Curriculum
  
  
• Education of Medical Students in Ophthalmology