Dear Ms. Moss,

As a fellowship-trained ophthalmologist who has educated resident physicians for over ten years in clinical and surgical ophthalmology, I have grave concerns regarding draft regulations regarding proctoring for individuals seeking laser eye surgery privileges without extensive training or residency experience.

In training residents to perform any procedure, especially laser surgeries on the eye, close in-person demonstration and observation on a live patient with safety and accuracy being constantly monitored is absolutely necessary.  There is a great deal of irreparable harm that can be done by poorly placed laser shots.  Too little laser energy can be ineffective, too much can cause life-long visual complications. 

I would add that, as with any surgery, patient selection is paramount and the decision not to perform a procedure is as important as the decision to proceed with one.  For example, a yag capsulotomy is a relatively benign and common procedure performed for poor vision after cataract surgery; however, if a patient’s poor vision is due to an incorrect intraocular lens, a laser procedure done too hastily will make it essentially impossible to have a surgical lens exchange performed and doom a patient to further procedures and difficult-to-correct visual deficits. 

Ophthalmologists perform hundreds of different types of laser procedures during their years of training, starting in their first year with close observation and oversight, with an attending physician walking them through patient selection, clinical decision making, the process of performing the laser surgery, the specific techniques of the procedure, post-operative patient education, follow-up, and management of complications.  They are given more autonomy as they demonstrate mastery of each portion of the procedure.  There is certainly much more to it than flipping on a laser, pushing a button, and zapping some holes.

As such, I must strongly recommend changing draft regulations to maximize training and observation of actual procedures, and extensive education on the selection of patients for procedures.  Having been referred many patients that suffered complications, at times blinding ones, from inadequate or inappropriate outpatient care, I cannot recommend enough caution in training and expanding oversight.  Overall, I fear patients will be showing up in my emergency department with more complications from unnecessary and incorrect elective procedures; all steps must be taken to prevent this from happening to patients in Virginia.

Sincerely,

Giovanni DiSandro, MD

EVMS Ophthalmology

Residency Program Director

Medical Director, Sentara/EVMS Lions Center for Sight