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Discuss range of options with spectacle wearers who want refractive surgery
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Share findings, discuss all options
Robert Ryan, OD: With the popularity of LASIK fueled by aggressive marketing campaigns, the number of inquiries practitioners receive on a daily basis is not surprising. How we address these questions may have a tremendous impact on the long-term vitality of our practices.
As is the case with any encounter, I feel it is prudent to share our clinical findings with our patient and discuss all potential treatment options. This is true whether we diagnose the presence of cataracts, keratoconjunctivitis sicca, diabetic retinopathy, infectious keratitis or suspect glaucoma. While medical management of our patient base has undoubtedly stimulated renewed enthusiasm, we must not lose sight of our core competency of managing refractive error. Our training prepares us like no other profession to guide patients to the most appropriate level and means of visual correction.
Patients deserve to be thoroughly educated about the potential risk, benefit and limitations of any suitable means of correcting their refractive error. Most are already familiar with issues surrounding spectacle use and the opportunity to alter this with a simple change to new eye wear or prescription. It is imperative that they completely understand that less-than-desirable surgical outcomes may be difficult to manage. This is part of the informed consent process that should also outline more conventional options, among which would certainly include contact lenses.
In addition, many patients are unaware of recent advances in the contact lens industry that may make contact lenses a more attractive option. Excellent quality disposable spherical, toric and daily lenses with generous parameter ranges have allowed many previous lens dropouts to re-explore contact lenses. The re-emergence of continuous wear, spurred by the development of silicone hydrogel materials, has certainly offered myopic patients what appears to be a safe and convenient alternative to surgery.
Corneal refractive therapy, precision molding via contact lens wear, is showing significant promise for mild to moderate myopic astigmats to be device-free during waking hours. Presbyopic patients, whose only mainstream surgical solution today is monovision, have numerous multifocal contact lens designs available in both rigid and hydrogel materials.
Explaining that refractive surgery in no way discourages future refractive changes serves notice that corrective lenses may again become necessary over time. Obviously, with contact lenses and spectacle wear, improved vision is as simple as filling a new prescription. Only when patients clearly understand all these issues can a truly informed decision be rendered.
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Educate patients to keep them
Scot Morris, OD: In any eye care practice, when a patient asks about his or her visual correction options, it is our responsibility to provide and discuss all three options: spectacles, contact lenses and refractive surgery. Though patients may be excellent candidates for one of the various refractive surgeries, part of any informed consent is to advise patients that there are other means for correcting their vision, including glasses and contacts.
During a refractive surgery consultation, many patients are found not to be perfect candidates for refractive surgery due to either physical or “psychiatric” issues. For those patients, glasses or contacts continue to be viable options for correcting their refractive error.
Glasses and contacts offer excellent vision at a comparable price over the course of a lifetime without the risks of surgery. Though many people pursue refractive surgery as an option to correct their vision without the “hassle” of glasses or contacts, a poor surgical result may be more of a hassle than other corrective options. Patients seeking advice from their eye care providers deserve to know their options, and ultimately it is their decision as to what option is best for them.
As eye care providers, it is our responsibility to educate our patients to the best of our ability on all of their refractive correction options. Our patient population is very well educated, and failure on our part to provide the information that they seek may often lead to patients seeking information and care elsewhere.
How do you keep patients in your office? Educate them and let them decide.
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Contact lenses are safer
Glenda Secor, OD: Yes! With the plethora of new contact lens designs, materials, replacement schedules and regimens, today’s professionals should always discuss the availability of contact lenses as an option before refractive surgery. It has been well documented that previous contact lens failures can often become successful with simple changes to design or care system. Talking with patients and listening to their history can indicate areas of non-compliance or problems that could be rectified with simple patient education.
Even though practitioners and the public have embraced refractive surgery, not every patient is thrilled by the idea of surgically correcting his or her vision if another option is available. Technology continues to change, and in my opinion, contact lenses are still safer than irreversible surgery.
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