Managing Expectations in Refractive Surgery

Abstract

Success in refractive surgery requires equal parts clinical insight and setting and managing appropriate patient expectations. Preoperative expectations predict satisfaction following refractive surgical procedures, and managing these expectations is essential to achieving a successful refractive surgical experience for both the surgeon and the patient. In this review, we describe our approach to managing expectations for laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and phakic intraocular lenses (PIOLs). We provide an overview of patient selection, preoperative patient counseling, postoperative visual acuity and refractive results, and refractive stability. We discuss the large published reviews comparing outcomes of surgical procedures pitted against one another as well as postoperative issues, including night vision complaints, contrast sensitivity, and surgical complications. Finally, we comment on overall patient satisfaction following these life-altering surgical procedures. ' Patient and Procedure SelectionThe clear goal of any refractive surgical procedure is spectacle independence, and the first step in reaching this goal is to determine which techniques are appropriate to treat the individual patient. The decision must be based on the patient's refractive error and the findings of a full ophthalmic history and examination. Then, based on patient age, profession, and hobbies (visual needs), the surgeon and patient should collaboratively and objectively set visual goals for refractive surgery.

Role of the treating surgeon in the consent process for elective refractive surgery

“…As refractive surgery has become more popular, there is an increasing public awareness of the procedures 29–31. Prospective patients have access to nearly unlimited online information that can combine scientific facts with unfounded assertions, a process that has become known colloquially as “Dr Google.” Accordingly, patients need to be given precise information to help them with their decision process and ensure they have realistic expectations about the benefits and potential risks of the procedure.…”

Avaliação do conhecimento sobre cirurgia refrativa por meio de questionário eletrônico

“…(2) Em linhas gerais, o paciente deve entender e ser consciente de que sua acuidade visual sem correção após o procedimento não deve ser melhor que sua acuidade visual corrigida pré-operatória, embora isso seja possível. (5) De maneira análoga, o paciente présbita não deve esperar que sua visão de perto seja corrigida sem que haja uma compensação em um dos olhos. Tais expectativas pré-operatórias podem gerar queixas e estão diretamente relacionadas com a insatisfação pós-operatória.…”

“…Tais expectativas pré-operatórias podem gerar queixas e estão diretamente relacionadas com a insatisfação pós-operatória. (5,6) Em pesquisa encomendada pela então Sociedade Brasileira de Cirurgia Refrativa (SBCR), atual Associação Brasileira de Catarata e Cirurgia Refrativa (ABCCR), com o objetivo de reconhecer questões sobre esse mercado no Brasil, (2) foram considerados altos tanto o nível de satisfação dos pacientes submetidos à CVL quanto a recomendação para que alguma outra pessoa realizasse a cirurgia. Por outro lado, dentre os pacientes entrevistados, 60% dos não operados disseram que jamais tinham conversado sobre cirurgias refrativas com seu oftalmologista.…”