In the early days of LASIK, there was a lot of talk about how best to manage disappointed patients. Message boards and websites were booming with horror stories posted by infuriated, depressed patients whose outcomes did not match their expectations. Likewise, Review’s coverage of refractive surgery was heavily slanted toward how you could best deal with these unhappy patients—on both a clinical and an emotional level.
In October 2001, for example, the cover of Review’s
Refractive Surgery Report was filled with images depicting severe DLK,
keratectasia, and other “LASIK Letdowns,” as we referred to them in that
month’s featured continuing education program. Included in the report was an
explanation of emotional responses to less-than-ideal surgical outcomes, as
well as a feature on how to soften the blow of “LASIK Realities” in patients
who needed glasses post-op. Year after year, you’d find more of the same in
this popular annual report.
Fast forward to the present day. While conversation about
devastating outcomes still persists in small circles, it has died down
substantially. Obviously, enhanced technology and subsequent improved outcomes
are largely responsible for this shift. But, to an even greater extent, the
entire dialogue surrounding refractive surgery has changed—within the eye care
profession as well as between doctor and patient. Nowhere is this change more
evident than within the pages of this month’s issue.
This year’s Refractive Surgery Report opens with a frank
editorial by John Potter, O.D., M.A., who tackles a not-so-glamorous topic, but
arguably the single most critical one in elective eye care: informed consent.
Bridge the Gap in Informed Consent”).
Dr. Potter, who works for TLC, has spent the last six years
devoted to resolving disputes and conflict resulting from refractive surgery.
He says, “In my experience, most patients involved in a dispute or conflict
generally argue that they were not adequately informed about the possibility of
unexpected results following a procedure. Likewise, the surgeons who operated
on these patients almost always reply that they definitely provided informed
consent and have the signed and properly-executed document in the patient’s
record to prove it.”
Obviously, both doctor and patient cannot be telling the
truth. Or can they? Was something lost in translation? Dr. Potter’s provocative
editorial challenges O.D.s to find a middle ground between their big-picture
views and their patients’ more self-centered ones. If so, then patients’ ears will
be open during this vital discussion and, in the event that a complication does
occur, the doctor will remain a trustworthy resource, rather than a negligent
No doubt, Dr. Potter would be proud of a program that one of
his colleagues, Jim Owen, O.D., created for his practice. Called “Just Like My
Mom,” Dr. Owen’s program helps him ensure that his premium IOL patients
understand all of the limitations of these lenses because, although they are
exceptional, no lens is perfect for every patient.
In “A Patient-Centric View of Premium IOLs,” Dr.
Owen says that when his own mother was ready for an IOL, he “never once said
‘apodization’ or tossed around other jargon.” Instead, he translated a highly
scientific discussion into a much more meaningful one by asking very specific
and direct questions such as, “Will you be OK with glare at night?” and “Are
you willing to wear reading glasses for small print and close work?”
adjustment in how you present options can make an enormous difference in
patients’ postoperative satisfaction levels as well as in the technology’s
future success, which so often is influenced by public perception.
Without a doubt, professional media coverage of refractive surgery has
changed—and not because there is just cause for higher expectations (which,
obviously there is). Rather, the focus has shifted because doctors have been
more effective in educating patients and in managing their expectations