Training refractive surgeons and expanding access to eye surgery

Refractive surgery trainees now learn 5 procedures instead of 2, but the surgery itself is not the hardest part to teach. In a video interview with Ophthalmology Times, Isa S. K. Mohammed, MD, director of refractive surgery and associate program director of the residency program at the Johns Hopkins Wilmer Eye Institute in Baltimore, Maryland, discussed how he trains residents and fellows and what still limits access to cataract and refractive surgery worldwide.

What is the hardest part of teaching refractive surgery?

Historically, trainees learned LASIK and photorefractive keratectomy (PRK). Today, Mohammed said, they also learn small incision lenticule extraction (SMILE), implantable collamer lens (ICL) surgery, and refractive lens exchange, along with the subtleties of different laser platforms. Many skills from other eye surgeries carry over, he noted.

“I would say the biggest challenge is not actually the surgery itself, but managing expectations with postop outcomes, where you want to make sure that you’re always underpromising and overdelivering,” Mohammed said. Choosing the right patients and the right surgery for each patient also matters, he said. “The actual surgery itself, most surgeons will tell you it’s pretty straightforward and you can learn it pretty quickly,” he said.

To teach that judgment, Mohammed shares a methodical process: the questions his technicians ask patients, how he approaches imaging, and how he ranks which options would be best, which might be acceptable, and which would be contraindicated.

What limits access to refractive surgery worldwide?

Refractive errors and cataracts are the leading causes of vision impairment and blindness worldwide, according to the World Health Organization (WHO).¹ Mohammed noted that the problem affects tens of millions of people and that many of these cases could be corrected. In cataract care, there has been considerable progress, he said, driven by surgeons who train local ophthalmologists, nurses, and staff and help build infrastructure before leaving. “And the big thing there is empowering the local community,” he said.

Refractive surgery faces a harder hardware problem. “So for cataract surgery, we’ve learned to be able to do it with very, very minimal, low-expense equipment, which does improve its accessibility,” Mohammed said. Refractive lasers, by contrast, carry costs in the hundreds of thousands of dollars and often must be housed in climate-controlled rooms. “It’s not really amenable to kind of going on the road,” he said. Mohammed discusses how he chooses among PRK, LASIK, SMILE, and phakic intraocular lenses (IOLs) and IOL selection after corneal refractive surgery in part 1 of this interview.

Reference
1. Blindness and vision impairment. World Health Organization. February 10, 2026. Accessed October 27, 2026. https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment