Discuss refractive surgery with all interested candidates

Issue: June 2006

ByMichael D. DePaolis, OD, FAAO

Michael D. DePaolis, OD, FAAO [photo]
Michael D. DePaolis

Where have all the refractive surgery patients gone? It’s a question that optometrists often ask these days. Comparatively speaking, many optometrists feel that they are comanaging fewer refractive surgery patients than they did 4 or 5 years ago. Of course, the real question is, why?

In some situations it’s merely a perception. In progressive primary eye care practices, refractive surgery comanagement has become almost mundane. These patients flow through the practice daily and, as such, “blend” with other patients. Not commanding much fanfare or attention, today’s refractive surgery patient simply goes unnoticed.

In these practices, a year-to-year comparative proves that refractive surgery comanagement is alive and well. Unfortunately, this is more the exception than the rule.

Why a decline in comanagement?

There are a variety of theories as to why optometrists are comanaging fewer refractive surgery cases today. One plausible explanation is that the “pent up” refractive surgery demand of the late 1990s is no longer there. While it’s true many early adopters have had LASIK surgery, the candidate pipeline is flush with new, emerging ametropes.

Another theory contends we’re in a technology “holding pattern,” with potential patients waiting and assessing phakic IOLs before making a surgical decision. Moreover, while certain patients, especially presbyopes, are apt to wait for newer technologies, it’s also true that newer options pique interest in refractive surgery – an interest that drives additional LASIK procedures.

Finally, we have the notion that optometrists have just become too busy – too busy prescribing newer contact lens options, caring for baby boomers and attending to a growing therapeutic practice. In short, optometrists are too busy to comanage refractive surgery patients.

Regardless of the reason, one fact remains. Refractive surgery demand and procedure volume remains strong. So, where are these patients going?

Patients going direct to surgeon

Statistics suggest a trend in which patients are less likely to first visit their primary eye care provider – optometrist or ophthalmologist. Rather, these prospective candidates are more likely to directly consult with the refractive surgery practice. Maybe it’s because the public has become more confident about refractive surgery and views the technology as infallible. On the other hand, perhaps it’s because patients perceive that “going direct” saves time and money. Either way, today’s LASIK candidate appears more likely to bypass his or her family eye doctor.

While trends change, our responsibility remains constant. Provide patients with exceptional eye care. Whether performing a specific service or referring for a specialty consult, it is imperative that we offer patients a factual and balanced opinion.

This is why this recent trend is so significant. It’s not our job to talk patients into or out of refractive surgery. It’s not our place to convince all patients that co-management is the best option.

It is our responsibility to watch for our patients’ best interests. This means discussing refractive surgery with all interested candidates. Be sure they understand each option and its ramifications. Most importantly, be sure they know you’re readily available to provide an opinion – the opinion that is best for them.