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Cover Focus | Apr 2015

CRST Europe Readers Sound Off: Presenting LASIK to Patients

How have you changed the way you present LASIK to your patients—in other words, what do you do now to present LASIK as an attractive surgical option? 

John S.M. Chang, MD

Recently there has been bad press on LASIK in Asia from a doctor in Taiwan, from the consumer council in Japan, and from the press in Korea. As a result, many refractive surgeons practicing in Asia have switched to the ReLEx SMILE procedure and claim it does not have the problems LASIK has. However, I tell my patients the following:

1. Corneal refractive surgery has been around for nearly 50 years. Because it is not a new procedure, we know it very well by now.
2. The cornea gets tougher with age, so degeneration is unlikely to show up 20 years later.
3. The US Army has performed more than 0.5 million cases of LASIK since 1999, and they have continually monitored these soldiers. If LASIK was not safe, they would have stopped offering the procedure by now.   

Arthur B. Cummings, MB ChB, FCS(SA), MMed(Ophth), FRCS(Edin)

I tell patients that more refractive surgeons have had LASIK than any other profession pro rata. I tell them that the literature now suggests that LASIK is safer than contact lens wear.1,2 I tell them that, traditionally, the biggest fear has been post-LASIK ectasia, and, because we can do CXL, post-LASIK ectasia is simply no longer remotely the same concern as it was before. Concerns such as glare can also be put to bed when we are able to offer wavefront- and topography-guided procedures.

We have hung photographs in our clinic of staff members who have had LASIK, and this also generates a feeling of comfort and security for the prospective patient. Those who are interested in LASIK are shown the refractive suite that we use for the procedure. It is a sleek laser setup and converts a lot more patients than it scares off. We also have thick photo albums full of hand-written thank-you cards from patients lying around the clinic. Reading these give patients a great sense that they are in the right place and that LASIK is a great procedure.

1. Schein OD, Katz J. Comparing contact lens and refractive surgery risks. Arch Ophthalmol. 2007; 125(6):853-854; author reply, 854-855.

2. Mathers WD, Fraunfelder FW, Rich LF. Risk of lasik surgery vs contact lenses. Arch Ophthalmol. 2006;124(10):1510-1511.

Detlef Holland, MD

We perform femto-LASIK with the latest-generation excimer laser in our clinic and introduce the procedure to patients as a highly safe, predictable, and efficient surgery with more than 25 years of solid clinical evidence supporting it. We explain that, because we treat our patients in the evidence-based range of refractive error and exclude unsuitable eyes, the risks associated with LASIK are absolutely minimized.

Aylin Kilic, MD

Many educational resources available on the Internet can be a fantastic resource for our patients. However, these can sometimes overwhelm patients or scare them away from having the procedure. Just 20 years ago, there were only 130 websites total, and Google was not yet in existence; 10 years ago, Skype, Facebook, YouTube, Reddit, Twitter, Tumblr, Dropbox, and Instagram did not exist. In 2003, fewer than 1% of all telephones were considered smartphones. Today, the Internet hosts thousands of websites, but, unfortunately, those dedicated to LASIK information range from being incomplete and deficient, to requiring a high reading level to understand, to those that present the procedure in a positive light. Patients relying on Internet content to make LASIK decisions could be negatively influenced by deficiencies in the information provided, and we must always keep this in mind when counseling patients.

Recently I have felt more pressure than ever before to give patients detailed and scientific evidence on LASIK and LASIK technology, as I believe it helps to make the procedure a more attractive option. Vision quality is more important to patients than spectacle independence, and talking to them about customizable treatments, iris registration, precise astigmatism correction, and eye-tracking systems can reduce patient anxiety and inform them that LASIK can help them to achieve their visual goals. Because patients can read about different kinds of refractive surgery methods online and in company literature, I have many more patients coming in for consultations with specific questions than I had in the past. I believe that my new approach has helped to ease patient concerns and to present LASIK positively.  

Dan Z. Reinstein, MD, MA(Cantab), FRCSC, DABO,

I tell patients that LASIK can be used to correct presbyopia (reading vision) as a 10-minute procedure that heals in a few hours, without having to take the risk of going inside the eye and replacing the natural lens with a lens that splits light to achieve reading vision.