Definition and Overview

A refractive surgery consultation is an appointment with an ophthalmologist (eye specialist) to determine if refractive surgery is the best form of treatment for the patient's vision problems.

Refraction refers to the bending of light as it passes through the cornea and into the retina, where the light is converted into electrical impulses that can be interpreted by the brain. The bending process is important so that just enough light is perceived by the eyes.

Refractive errors affect how much light goes through the eyes and distorts the image a person sees. There are many different types of refractive errors. These include:

  • Nearsightedness (myopia) – This condition is characterized by a person’s inability to see objects that are far.
  • Farsightedness (hyperopia) – This condition refers to the person’s inability to see near objects.
  • Presbyopia (age-related) – A person with presbyopia cannot see objects clearly as the eyes are having trouble focusing. This is age-related and commonly affects people who are 60 years old and above.
  • Astigmatism – In the case of astigmatism, there is an abnormality in the shape of the cornea causing blurry vision. The cornea is the part of the eye that is found at the front. It is transparent and made up of hundreds of cells and proteins. The shape of the cornea, which is normally round, can help determine how much light the eyes can focus on.
  • Keratoconus – This is a progressive eye condition wherein the shape of the cornea changes from being round to conical as the layer becomes thinner.
    These eye problems can be corrected by a number of refractive surgical techniques, which include:

  • LASIK (laser in situ keratomileusis) - this is currently the most common type of surgery to correct vision problems. It uses laser to reshape the inner cornea.

  • LASEK (laser epithelial keratomileusis), this creates a flap on the epithelial tissue and laser is used to reshape the cornea
  • RLE (refractive lens exchange) - in this technique, the eye’s natural lens is replaced with a lens that is made of plastic or silicon
  • PRK (photorefractive keratectomy) - this is ideal for mild vision problems

Who Should Undergo and Expected Results

A person may consider seeing an ophthalmologist for a refractive surgery consultation if:

  • He doesn’t want to wear glasses and contact lenses anymore – The easiest way to correct vision problems is by wearing prescription glasses and contact lenses. However, they can be cumbersome or tiring to wear over time. Further, in certain cases, the condition of the eyes can worsen, in which case new types of glasses or contact lenses would have to be prescribed.
  • The person has vision problems caused by refractive errors mentioned above
  • The person is referred by another specialist, which could be another ophthalmologist who doesn’t subspecialize in surgery
  • The person likes to get a second opinion – a person who’s undecided to go through the surgery or doubts such recommendation can approach another surgeon for a second opinion.
    During consultation, the patient should be able to get the following information:

  • Eligibility for the procedure

  • Best surgical technique
  • Risks and complications
  • Long-term effects of the procedure
  • Expectations
    Patients should know that refractive surgery doesn’t always correct vision problems completely. However, more often than not, it significantly reduces dependence on glasses and lenses, including intraocular lenses (IOLs). This results in improved quality of life of the patient and increased mobility.

How Does the Procedure Work?

Before the patient undergoes a refractive surgery consultation, he needs to take a vision test. Depending on the result of such test, the patient may then be referred to an ophthalmologist who will perform the refractive surgery.

Prior to the actual consultation, the patient goes through more thorough eye exams, which can be accomplished by a trained staff or a nurse. The patient also needs to provide the following information: medical history, medications taken, and treatments undergone to correct the vision.

During the appointment, the surgeon would go through all the medical records and personal information provided by the patient. He then:

  • Determines whether the patient is eligible for surgery – Considering the possible risks and complications that come with surgery, an ophthalmologist may not recommend it if the condition is mild or the person has an existing eye disease or condition that can make these risks worse.
  • Provides different options to patients and guides them during the decision-making process
  • Describes the procedure including the equipment and techniques to be used, pre-surgical and post-surgical care, recovery period, and risks and complications.
  • Calculates the possible costs and how the patient can maximize insurance coverage, if he has any
  • Schedules the best time for surgery
    The consultation may take at least an hour including the vision tests. Succeeding consultations are expected to be shorter as the major points have already been discussed during the first time.

Possible Risks and Complications

Not everyone is eligible to go through refractive surgery, and for a patient who receives no for an answer, that can be very frustrating. He might view the consultation process as useless and a waste of time. He may also need to start another consultation with a different eye specialist.

Further, the expectations of the patient and the doctor may be different, which can make any consultation more complex. Usually, this stems from the wrong belief that a refractive surgery can totally eliminate all types of eye problems. They may then become disappointed or upset if the possible outcomes do not meet their expectations. For this reason, it’s important that the surgeon can cover all bases about the surgery, including the short- and long-term results.

For safety, patients are advised to approach only board-certified refractive surgeons. A number of patients have already experienced trauma due to botched eye surgeries after working with a non-certified or unlicensed surgeons.

References:

  • Mimura T, Azar DT. Current concepts, classification, and history of refractive surgery. In: Yanoff M, Duker JS, Augsburger JJ, et al. Ophthalmology. 3rd ed. St. Louis, MO: Elsevier Mosby; 2008:chap 3.1.

  • Questions to ask when considering LASIK. San Francisco, CA. American Academy of Ophthalmology. Available at: http://www.geteyesmart.org/eyesmart/glasses-contacts-lasik/lasik-questions-to-ask.cfm.

  • Young JA, Kornmehl EW. Preoperative evaluation for refractive surgery. In: Yanoff M, Duker JS, Augsburger JJ, et al. Ophthalmology. 3rd ed. St. Louis, MO: Elsevier Mosby; 2008:shap 3.2.

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