Discussion of Findings and Informed Consent
After completing the evaluation, the surgeon must analyze the information and discuss the findings with the patient. If the patient is a candidate for refractive surgery, the discussion must include the risks and benefits of the medical and surgical alternatives. (Table 2-2 provides an overview of the most common refractive surgery procedures, their typical refractive ranges, and their key limitations.) Significant aspects of this discussion are the expected visual acuity results for the amount of refractive error (including the need for distance and/or reading glasses, the chance of needing an enhancement, and whether maximal surgery is being performed during the initial procedure), the risk of decreased BCVA or severe vision loss, the adverse effects of glare and halos or dry eyes, the change in vision quality, and the rare need to revise a corneal flap (eg, for flap displacement, significant striae, or epithelial ingrowth). The patient should understand that the laser ablation may be aborted if there is an incomplete, decentered, or buttonholed flap. The pros and cons of surgery on 1 eye versus both eyes on the same day should also be discussed, and patients should be allowed to decide which is best for them. Although the consequences of bilateral infection are higher with bilateral surgery, serial unilateral surgery may result in temporary anisometropia and is more inconvenient. Nonsurgical alternatives, such as glasses and contact lenses, should also be discussed.
Table 2-2 Limitations of the Most Common Refractive Surgery Procedures
If a patient is considering refractive surgery, he or she should be given the informed consent document to take home and review. The patient should be given an opportunity to discuss any questions related to the surgery or the informed consent form with the surgeon preoperatively. The consent form should be signed before surgery and never when the patient is dilated and/or sedated. For sample informed consent forms, see the website of the Ophthalmic Mutual Insurance Company (OMIC; www.omic.com/risk-management/consent-forms/).
Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.