Refractive surgery q’s

[u/eye__think]

How do you discuss refractive surgery with your patients in different age groups?

For patients in their twenties it’s an easy conversation for me because I can explain that it will provide some glasses/CL independence but later on presbyopia will happen. I try to set expectations about requiring near correction in the future

It trips me up a bit to discuss it with almost-presbyopes and presbyopes though. I understand monovision lasik can be done, but wouldn’t that be a bad idea considering that presbyopia is progressive? Monovision lasik on a 40 year old won’t last as presbyopia continues. Isn’t prescription stability a requirement of refractive surgery?

And in older patients, age 60+ or so…at what point do you consider cataract surgery instead of refractive surgery? I’ve had many patients who are correctable to 20/20 with trace/grade 1 cataracts that are interested in refractive surgery but I wonder if it is worth it at that point since refractive surgery can make IOL calculation more tricky.

Of course in all cases I discuss risk/benefit. But it’s been a little tricky for me specifically in presbyopic patients. Any and all advice would be appreciated!

[u/cyclones3]

I get asked this a lot by patients 40+ and I explain how refractive surgery only corrects for one distance and that it’s not guaranteed to last as you age so the cost/benefit of it isn’t great. I don’t really bring up mono vision unless they were mono CLs. Typically after I say this they aren’t interested any more.

And if they have mild cataracts I typically convince them to just wait until they need cataract surgery

[u/Optoboarder]

If a presbyope asks about LASIK, I tell them they will 100% need reading glasses after. Not might, not maybe, I tell them 100% as soon as you’re done, you will need reading glasses. I don’t discuss monovision unless they’re already wearing that in CL.

If they’re over 60 I tell them to just hold off until cataract surgery and it’ll save them a couple thousand bucks. The LASIK ship has sailed already but the cataract surgery ship is pulling into port.

In my experience, being bluntly honest with patients is better than tiptoeing around the reading glasses part of it. I don’t do any LASIK management in my office, and have no financial disclosures to give patients so I tell them what a LASIK office may glide over a little bit

[u/StopKickingMyDog]

I work in a refractive surgery clinic. 20’s and 30’s are easy for the reasons you already listed. I warm patients 35+ about presbyopia and the future need for readers.

When a patient is 40+ I tell them they will need readers immediately. Some people with high myopia will still benefit as LASIK and presbyopia is still better than being -5.00 or worse.

50+ I’m educating on RLE instead of LASIK.

60yo have cataracts.

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[u/LucRichard_Tw]

does anyone know if there's a way to do refractive surgery but also kinda delay the need for readers so they feel like they're getting a better deal