Refractive Surgery Education through Secure Remote Supervision of Excimer and Femtosecond Laser Platforms

Abstract

Background: Refractive laser surgery is challenging to teach in routine clinical practice because it is predominantly performed in a self-paying patient population, where expectations regarding surgeon experience, procedural efficiency, and safety are particularly high. As a result, structured hands-on training in procedures such as laser in situ keratomileusis, photorefractive keratectomy, and small-incision lenticule extraction is often limited to high-volume specialist centers and requires substantial consultant availability. Aim: To describe the implementation of a secure remote supervision system for refractive laser surgery integrating femtosecond and excimer laser platforms, and to discuss its potential role in surgical education within a private practice environment. Methods: A secure video supervision infrastructure was adapted to include live video streams from refractive laser platforms and operating microscopes. Video signals were transmitted within an on-premises institutional network and accessed by authorized supervising surgeons through encrypted connections. Audio communication allowed real-time advisory feedback during key procedural steps, including patient positioning, docking, centration, laser delivery, flap or lenticule management, and intraoperative decision-making. The system was implemented as an observational and advisory workflow tool without altering sterile technique or standard surgical responsibility. Results: Integration of remote supervision into the refractive laser workflow enabled consultants to provide immediate guidance while preserving trainee autonomy and procedural efficiency. The system supported supervision across multiple procedural stages and reduced the requirement for continuous physical consultant presence in the laser suite. This model may be particularly relevant in private refractive practice, where trainee participation must be balanced against patient expectations, time efficiency, and economic constraints. Conclusion: Secure remote supervision of excimer and femtosecond laser platforms may provide a scalable model for refractive surgery education. By extending expert oversight beyond direct in-room supervision, this approach could help bridge the gap between surgical training and the realities of private refractive practice while maintaining patient safety, data protection, and procedural efficiency.

Keywords: Refractive Laser Surgery; LASIK; SMILE; Surgical video.