Eun Kyoung Lee1,2, Young Keun Han1,2,3 Satisfaction level of the physicians who have undergone corneal refractive surgery Eun Kyoung Lee1,2, Young Keun Han1,2,3 Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute1 Department of Ophthalmology, Seoul National University College of Medicine2 Department of Ophthalmology, Seoul National University Boramae Hospital3 The authors have no financial interest

Background & Purpose Corneal Refractive Surgeries Purpose Is laser eye surgery still safe for doctors who perform sophisticated operation?? “Mostly eye doctors wearing glasses..” “Ophthalmologist, won't get LASIK even though he offers it to his patients..” Purpose To evaluate satisfaction level of the physicians who have undergone corneal refractive surgery By comparing physicians with other healthcare workers & By comparing medical physicians with surgeons

Patients and methods Retrospective comparative study Between January 2005 and January 2010 Seoul National University Boramae Hospital Surgical techniques Corneal Refractive surgery: LASIK/LASEK By same surgeon (Y.K.Han) Patients 212 eyes of 107 patients Age, Sex, Occupation, Medical subspecialties, Types of corneal refractive surgery etc. Group I: Physicians Group I-A: Surgeons & Doctors using microscopes Group I-B: Medical physicians Group II: Other health-care workers (HCW’s)

Patients and methods Main outcome measure Statistical analysis Clinical characteristics : SE (spherical equivalent), BCVA (best corrected visual acuity) at preop & postop Satisfaction about visual symptom after surgery : Visual Function Index (VF-14) questionnaire Statistical analysis : SPSS 17.0 : Mann-Whitney U test, Paired t test The VF-14, An Index of Functional Impairment in Patients With Cataract Arch Ophthalmol vol 112, May 1994

Healthcare worker group Results Demographic data Table 1. Preoperative patient characteristics Variable Physician group Healthcare worker group P – value No. of patients 51 56 - No. of eyes 100 112 Sex (M/F) 7/44 10/46 0.559* Age (years) mean 28.88 ± 2.80 27.88 ± 4.48 0.163† range 24 ~ 37 23 ~ 41 Sphere (D) -4.47 ± 1.82 -4.20 ± 1.57 0.415† Cylinder (D) -0.92 ± 0.61 -0.77 ± 0.68 0.218† Spherical equivalent (D) -4.93 ± 1.81 -4.58 ± 1.58 0.293† Mean ± S.D. *: Chi-square test †: Student t test 212 eyes of 107 patients, M:F = 17:90 Group I (100 eyes of 51 pts): I-A (41 eyes of 21 pts), I-B (59 eyes of 30 pts) Group II (112 eyes of 56 pts) Mean age : 28.36 ± 3.79 yrs (23~41yrs)

Healthcare worker group Results Demographic data Table 2. Occupations and medical subspecialties Physician group Healthcare worker group No. (%) Group A Group B Dentistry 5 23.8 Anesthesiology 16.7 Nurse assistant 17 30.4 General surgery 3 14.3 Dermatology 1 3.3 Office clerk 11 19.6 Laboratory medicine 4.8 Emergency medicine Pharmacist 5.4 Obstetrics and gynecology Family medicine 4 13.3 Registered nurse 25 44.6 Ophthalmology 2 9.5 Internal medicine Orthopedic surgery Pediatrics 10 Otorhinolaryngology Psychiatry Pathology Radiology Plastic surgery Rehabilitation medicine 6.7 Urology Therapeutic Radiation Total 21 100 30 56 Group A = Surgeons or doctors using microscopes Group B = Medical physicians

Results Demographic data

Healthcare worker group Results Clinical characteristics Table 3. Postoperative results of patients Variable Physician group Healthcare worker group P – value UCVA (logMAR) -0.10 ± 0.06 -0.11 ± 0.09 0.985† Residual SE (D) -0.04 ± 0.31 +0.01 ± 0.42 0.510† Diameter of optical zone (mm) 6.11 ± 0.22 5.97 ± 0.82 0.215† Residual corneal thickness (μm) 382.79 ± 61.00 404.53 ± 51.94 0.055† Mean ± S.D. *: Chi-square test †: Student t test There was no statistically significant between-group difference in clinical characteristics

Results Satisfaction about visual symptom after surgery Table 4. Patient responses to questionnaire (Physicians vs. Healthcare workers) Question Mean score ± SD P – value Physicians HCW's Reading small print 3.61 ± 0.60 3.75 ± 0.58 0.217† Reading normal newsprint 3.76 ± 0.51 3.79 ± 0.56 0.841† Reading large newsprint 3.94 ± 0.24 3.95 ± 0.23 0.907† Recognizing faces at a distance 3.96 ± 0.20 3.91 ± 0.35 0.365† Going down stairs 3.90 ± 0.30 3.86 ± 0.40 0.518† Reading street signs 3.76 ± 0.55 3.59 ± 0.78 0.180† Sewing, doing delicate manual work 3.57 ± 0.64 3.61 ± 0.68 0.764† Reading mail, bills accurately 3.71 ± 0.54 3.73 ± 0.49 0.792† Playing cards 3.80 ± 0.40 3.73 ± 0.52 0.430† Going out to movies, plays, sporting events 3.78 ± 0.50 0.613† Cooking 3.82 ± 0.43 3.82 ± 0.47 0.981† Watching TV 3.73 ± 0.57 3.80 ± 0.48 0.444† Driving on day 3.59 ± 0.73 3.68 ± 0.61 0.485† Driving at night 3.31 ± 0.97 3.18 ± 0.94 0.465† †: Student t test *P < .05 No statistically significant difference between Physicians and HCW’s group in all items of VF-14 questionnaires

Results Satisfaction about visual symptom after surgery Table 5. Patient responses to questionnaire (Surgeons vs. Medical physicians) Question Mean score ± SD P – value Surgeons Medical physicians Reading small print 3.57 ± 0.68 3.63 ± 0.56 0.722† Reading normal newsprint 3.76 ± 0.54 3.77 ± 0.50 0.974† Reading large newsprint 3.90 ± 0.30 3.97 ± 0.18 0.365† Recognizing faces at a distance 3.95 ± 0.22 0.801† Going down stairs 3.90 ± 0.31 0.956† Reading street signs 3.86 ± 0.48 3.70 ± 0.60 0.321† Sewing, doing delicate manual work 3.62 ± 0.67 3.53 ± 0.63 0.643† Reading mail, bills accurately 3.71 ± 0.56 3.70 ± 0.54 0.927† Playing cards 3.76 ± 0.44 3.83 ± 0.38 0.537† Going out to movies, plays, sporting events 3.80 ± 0.55 0.793† Cooking 3.81 ± 0.40 3.83 ± 0.46 0.849† Watching TV 3.80 ± 0.48 0.267† Driving on day 3.50 ± 0.82 0.304† Driving at night 3.43 ± 0.81 3.23 ± 1.07 0.485† †: Student t test *P < .05 No statistically significant difference between Surgeons and Medical physicians group in all items of VF-14 questionnaires

Conclusion & Discussion No statistically significant difference in satisfaction level about visual symptom after corneal refractive surgery between physicians and other healthcare workers between surgical and medical physicians High reliability of study was achieved by retrieving control group of healthcare workers who work under the same circumstance of same temperature and humidity with physicians group It is conceivable that we may recommend corneal refractive surgery even to physicians who perform operation under bright light and use microscope for a long time

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