The concept of refractive surgery had its origin in the early 1980s with the advent of radial keratotomy (RK). As this surgical intervention was new and had irregular outcomes, it was not widely accepted or practiced in the Bay Area which has a more conservative medical philosophy than other regions of the United States. So, while there were practitioners in the Bay Area of Northern California who performed RK, this procedure was not practiced or taught by faculty of CPMC.

In 1995, photorefractive keratectomy (PRK) was approved by the FDA, and those who were able to purchase or use a laser platform for performing this excimer-based surgery for simple myopia on the VISX platform began performing PRK in the Bay Area. In 1995 laser-assisted in-situ keratomileusis (LASIK) became available as corneal surgeons combined the flap-making technologies used in lamellar corneal surgeries with the excimer laser. In 2001, “bladeless” LASIK using only lasers for all steps of LASIK surgery was approved by the FDA.

Though many ophthalmic surgeons in the traditionally conservative Bay Area did not embrace such techniques, the LASIK procedure became very well established at Stanford Medical Center. At that time, Stanford’s Department of Ophthalmology opened three Laser Vision Correction satellite centers in the Bay Area. Though Stanford had the choice of bringing Stanford Ophthalmology specialists to these Centers, they chose instead to appoint three Barkan Society members, Drs. Bob Sorenson, Dan Goodman and Bernd Kutzscher as Directors of these Centers. These Centers were later consolidated back at the new Stanford Byers Eye Institute when Dr. Edward Manche became its Director of Cornea and Refractive Surgery in 1996.

Andrew Sorenson
Andrew Sorenson, MD

The first CPMC resident to pursue the first of the newly offered corneal and refractive surgery fellowships was Dr. Andrew Sorenson who received his medical degree from UC San Diego and after his CPMC residency, completed a fellowship in refractive and corneal surgery at Duke University Eye Center under Dr. Terry Kim. In 2008, he was named chief of the newly established Refractive Surgery Service. He also serves as Medical and Surgical Director of the UC Berkeley School of Optometry Refractive Surgery Center where he is an Assistant Clinical Professor, as Chief of Ophthalmology at Alta Bates Medical Center and as a member of the Executive Committee for Hospital de la Familia Foundation.

Dr. Rich Abbott studied refractive surgery and developed both an incisional and laser refractive surgery service at CPMC, leading FDA clinical trials and teaching courses in refractive surgery for the Northern California community. Abbott went on to become full professor and Co- Director of Corneal and Refractive Surgery at UCSF. Other CPMC alumni added refractive surgery to their practices, including Drs. Mark Mandel, Kevin Denny, Bernd Kutzscher, Lee Schwartz, Robert Sorenson, and Scott Hyver. Also active in refractive surgery are the following Pacific Vision Eye Institute associated physicians: Dan Goodman, Jay Bansal, Margaret Liu, and Karen Oxford.

As part of the ongoing training in refractive surgery, residents have been able to perform LASIK and PRK surgeries on patients who are desirous of such procedures and with the support of the Lions Eye Foundation. Training has also included rotations with fellowship-trained corneal surgeon Dr. Mark Mandel who introduced refractive surgery to his private practice in the mid-1990s and has participated actively in resident training as an alumni faculty member.

Refractive surgery, as a private pay option for patients, creates a unique obstacle for resident opportunity. Residency training is not the ideal setting for learning elective refractive surgery such as LASIK, in part because patient quality demands are so high. Graduates of the CPMC residency who wish to include refractive surgery in their practices typically complete a specialized fellowship in refractive surgery. Among those who have completed refractive and corneal fellowships are Drs. Pulin Shah, Ethan Kutzscher, Bill Richheimer, Vincent Ray, Thomas Litzinger, Christian Hester, Adam Gess, Michael Clamp, Adrian Dokey, Ken Downes, Michael Hemond, Matthew Denny and Michael Ang.

In recent years, cataract surgery with lens implantation has focused increasingly on achieving high quality refractive results, on a par with LASIK and other refractive surgery procedures. CPMC residents are expected to master this complex surgery and to gain a high level of expertise through didactic, observational, and participatory care and enter their professions capable of engaging in the continually expanding area of this type of care known as refractive cataract surgery.