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One of the greatest challenges for the beginning LASIK surgeon is to explain the actual operation and the risks of the procedure with confidence and in a manner that informs without terrifying the patient. The choice of words will make a significant difference in the patient's perception of the procedure and the surgeon. Speaking in lay language, in a manner easily understood by the patient, is key to communicating the information needed to make an informed decision. A discussion presented with enthusiasm will help as well.

The explanation of the procedure and the risks should follow the examination. If the surgeon uncovers a contraindication to LASIK surgery, this can be explained and the consultation concluded without having gone through a detailed discussion.


Explain to the patient that the discussion will cover most of the commonly asked questions. Encourage the patient to interrupt if a particular point is not clear or if there is a question, and inform the patient that there will be time at the end to ask any additional questions. Remember the goals of the dialogue are both to inform completely and reduce anxiety. Anticipate your patient's questions and answer them before the patient needs to ask them. For example, if you wear glasses, anticipate that your patient will want to know why you haven't had the procedure. Have an answer prepared so you can present this information without being asked. This helps to instill confidence. Withholding information is improper and may increase anxiety and contribute to dissatisfaction with the surgery. Proper preoperative preparation will make the entire surgical process easier for the patient, surgeon, and staff. While many surgeons have others in the office explain the procedure and risks, there is an advantage for the surgeon to have the discussion personally. There is an opportunity to get to know this patient and determine his or her candidacy for the procedure from a psychosocial perspective. If the patient is unusually nervous, acts in an inappropriate way, seems inattentive or suspicious, or appears to have unreasonable expectations, he or she may be a poor candidate.

It is helpful to listen to one or more experienced surgeons present this material. A recording of the presentation or a typewritten script can help the beginning surgeon to prepare the first few discussions with prospective patients. Over time the surgeon will develop a talk that incorporates both the answers to questions that arise during discussion as well as portions of other doctors' presentations that seem to fit appropriately. When the presentation feels natural, the physician will appear self-assured and the patient will sense this.

Because one of the goals of the initial encounter is to instill the patient with feelings of confidence and comfort with the surgeon and staff, try to minimize the wait time in the office prior to the consultation and at every postoperative visit. During introductions, ask the patient how he or she prefers to be called and ask permission to address the patient in that manner.

Surgeon should discuss the possible risks of the surgery for example:

  • Vision expectations
  • Postoperative uncorrected vision expected given patient's refraction
  • Possible need for reading glasses and/or driving glasses
  • Possible need for retreatment to achieve visual goals
  • Night vision
  • Glare and haloes
  • Custom LASIK
  • Dry eye
  • Possible need for tears, medication, or plugs
  • Retinal detachment
  • Infection
  • Inappropriate flap
  • Too small or thin
  • Incomplete or off center
  • Flap striae
  • Ghosting
  • Possible need to lift flap to remove striae
  • Flap adherence
  • Flap displacement
  • Need for eye protection
  • Inflammation
  • Need for drops or pills to control inflammation
  • Possible need to lift flap to remove inflammatory material
  • Ingrowth
  • Possible need to lift flap for removal
  • Corneal ectasia
  • Need for contact lens wear
  • Need for cornea transplant
  • Postoperative ametropia
  • Over/undercorrection
  • Regression
  • Need and timing for retreatment

In general, the goal of the plan is to determine how best to address the following questions: What correction should be entered into the laser's computer? What is the appropriate treatment zone? What is the maximum ablation depth? What is the appropriate flap diameter? What is the ideal hinge position or hinge width? Once the answers to these questions have been determined, the surgeon must put this into language that the scrub technician and laser engineer can use with the available equipment at hand.

Even a surgeon should discuss the Lasik surgery procedure as well:

  • Optional need for sedation
  • Topical anesthetic reduces the urge to blink
  • Simultaneous vs. sequential surgery
  • Prep and drape
  • Lid speculum prevents blinking
  • Fixation light
  • Creation of flap
  • Pressure sensation
  • Lights become dim and go out
  • Sounds
  • Mechanical vs. laser flap creation
  • Flap assessment
  • Lifting the flap
  • Laser
  • Describe the type of laser
  • Tracker
  • Sound
  • Reposition the flap
  • Remove drape
  • Switch to fellow eye

Postoperative Information should be discussed in details for example:

  • Postoperative sensations
  • Vision hazy, but improved; nap speeds vision improvement
  • Scratchy irritation; acetaminophen or aspirin helps
  • Eye protection
  • Do not rub or touch the eyes for at least 1 wk after surgery
  • Use of protective eyewear
  • Avoid injury during eyedrop instillation
  • No swimming for at least 2 wk after surgery
  • Eyedrop instructions
  • Follow-up appointment
  • Physician's emergency number

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