What percentage of refractive surgery candidates do you decline?

The more diagnostic technology we have at our disposal, the better we are able to predict exactly who shouldn't get refractive surgery.

Joel Hunter, MD
Joel Hunter, MD
Refractive Surgeon, Hunter Vision Updated 10/31/18 11:07 AM

If you’re in search of short answer to a nuanced question like this, I’ll just say it right here at the beginning. Depending on the day, we tell between 15% and 30% of the patients coming in for a consult that they’re not a candidate for refractive surgery at this time. With that out of the way, feel free to read on for a little more detail that answers this question more fully. I’ve got a little anxiety about having the short answer right there at the beginning. It’s going to take me about an hour to write the rest of this and it’s possible no one will read it now that I gave away the farm at the start. So for the few who stayed, the details below are for you. You’re the reason I didn’t just put lorem ipsum filler from here on out.

Better Diagnostic Technology

The scale and scope of technology in refractive surgery is a two-sided coin. On one side, the more diagnostic technology we have at our disposal, the better we are able to predict exactly who shouldn’t get refractive surgery. When LASIK first became popular in the late 1990s, the level of diagnostics was as inferior to our current day standards as cell phones or computers were. Now we can see orders of magnitude more detail. Plus, we have the body of knowledge gained from millions of post-operative results. It means there are people who got LASIK in 1999 who would not be candidates if they were tested by today’s standards. Thankfully, the vast majority of them did well. That’s because being a non-candidate doesn’t mean you’re guaranteed a bad result, it means you don’t have a high enough guarantee of a good result. If the odds are 1% that you’ll do poorly with LASIK, you’re not a candidate. And we have the diagnostic technology today to reveal that with a ridiculously high degree of sensitivity.

Improved Procedural Technology

But there’s another side to the coin. Along with improvements in the diagnostic technology, there have been wonderful, science-fiction level improvements in the procedural technology as well. That means that there are patients who, by today’s diagnostic standards, wouldn’t be candidates for LASIK using lasers from 15 years ago, but are great candidates today. Almost daily, I get to tell someone, “You did yourself a favor by waiting.” The technology in lasers has matured to the point where people who are good candidates today shouldn’t have to wonder if something better is coming along. And because the technology in diagnostics has matured along with it, the people for whom something better is coming in the future can know it will mean they’re not a candidate at all for now.

Intra-ocular Lenses

The one other facet to the improvement in refractive surgery technology is the ability to use intra-ocular lenses to electively and proactively fix distance and near vision. The candidacy rate would be much, much lower without this option. Refractive lens exchange is an accurate and permanent way to get out of glasses for a lot of people who were told at one point that there is something better coming in the future. Their future is here now.

The technology we have today makes it harder to be a good candidate for refractive surgery by the standards of yesterday’s treatment options. Luckily, that same technological improvement means a lot of people are candidates for refractive surgery even with the significantly more exacting standards we get to use now. If you made it all the way to the end of this blog, even after I gave the answer at the beginning, I hope you’re a candidate most of all, because you’re a wonderful person and I am grateful for you.

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