Joel Hunter, MD Refractive Surgeon, Hunter Vision Updated 10/31/18 11:21 AM
Just to set the stage for this discussion, we should start with the fact that unless the chance stands at about 0% for you to need glasses after RLE, you’re nearly certainly not going to be a candidate for RLE. Every step of the RLE process matters a tremendous amount, and that starts with the moment you first walk through the door for a consult. If the person at the front desk calls you “dude” and then asks if they can borrow $20, you’d be justified in your concern about moving forward with the process. The big difference between that interaction and the diagnostic testing and interpretation during your exam is how much more difficult it is to discern if the exam is careful and competent.
Every step matters
The pre-operative testing has to be able to answer at least two specific questions to your satisfaction: Is this safe and will this work? The topic of safety is tackled elsewhere, but the short version is in most cases RLE easily meets the conservative safety standards necessary for an elective procedure. The second question about whether or not it will work is the topic of this article. “Will it work?” is a question of how high the chances are of going through the procedure and still needing glasses.
Will it work?
A specific standard must be met for the answer of “will it work?” to be a solid yes. That standard is this: the chance must be as close to 100% as is possible to predict in the real world that you won’t need glasses throughout your day. The reason it’s important to add the part about the real world is that sometimes people can lose a grasp on what’s possible not just in medicine, but in life. Maybe it’s because I’m a touch neurotic, but I’d feel really uncomfortable answering yes if someone asked me, “Is there a 100% chance a bear won’t break into my house tonight?” I mean, well, gosh… it’s incredibly unlikely, really it’s almost unimaginable. But it’s not technically accurate to say there’s a 100% guarantee it won’t happen.
Look at statistics
The difference in medicine and, to some degree, for refractive surgery specifically, is the insecurity of stepping into statistics that were never before applicable to you. Everyone has lived through many thousands of nights without a bear home invasion. No one who is coming in for an RLE consultation has had the procedure already and seen that it works. So we turn to what we always turn to in new and anxiety-provoking situations—statistics.
And the main problem with statistics is how statistics are truly unsatisfying unless they are 100%, which is true of almost no situational statistics. Yet, for nearly everyone—and it’s amazing how reproducible this is when the topic comes up—if they hear, “1 in 10,000 can get x, y, or z…” their next thought is, “well, of course I’ll be that person.” Oddly, it never works the other way. No one ever buys a raffle ticket and after hearing odds of 1 in 10,000 thinks, “well, of course I’ll be that person.”
The point of RLE is no glasses
The point of all this is the starting point for a discussion of RLE. The starting point is no glasses for near or distance vision. There may be modifying factors if you’re someone who solders microcircuitry all day or who has pre-existing conditions preventing full use of both eyes, but those cases are why honest consults matter. The point of RLE is no glasses. So while the chance can never be 100%, if it is much lower than that for any reason then RLE is usually not recommended in the first place. Every step of the journey matters. Those who have made it to the other side of RLE and no longer need glasses, they started in the same place you may be now. The first step is finding out if you have eyes capable of the goal of RLE. And that goal is no more glasses.