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Why does my optometrist tell me I’m not a candidate for LASIK?

By Joel Hunter, MD | 10/2/18 7:00 AM
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Maybe you clicked on this blog thinking, “I bet this will have some real Old West gun-slingin' words. I reckon this feller says optometrists’ words are none too welcome around these parts.” If so, I’m sorry to disappoint you. But also, wow would I like to hang out with you! Your internal monologue is delightful. And it’s on point with the typical optometry vs. ophthalmology “this town ain’t big enough for the both of us” mindset of conflict. That conflict often (this is true!) dominates the conversation in the world of eye medicine, which is hilarious because almost no one cares about it in the real and normal world where we all live. I imagine even finding out about this now must feel like visiting a small town and finding out that the citizens of it are bitterly divided and identify themselves based on whether they are associated with the local Moose Lodge or the Elk Lodge.

Optometrist vs. Refractive Surgeon

Anyway, one area that you might assume some conflict could arise would be in the opinion of an optometrist vs. a refractive surgeon on the idea of LASIK. Oftentimes, based on the information shared with me during LASIK consults, optometrists will tell a patient whether or not they are a candidate for LASIK. This doesn’t bother me. For a lot of people, their optometrist is the only eye doctor they’ll ever see, so it seems silly to expect they’d never speak on a relatively well-known eye procedure. As you’d imagine, this means sometimes an optometrist will tell a patient they’re not a candidate for LASIK when, in fact, they’re actually a great LASIK candidate. It’s bound to happen, and I’ve seen it multiple times.

Option One

There are only two options available to us as to why an optometrist would give a patient the wrong information about their LASIK candidacy. One, the optometrist sees a lifetime of glasses and contact lens prescriptions’ revenue going down the drain. “I prescribe glasses and contacts, so when this patient doesn’t need them, they’ll break up with me. I won’t let that happen. I will lie to them so that we can be together forever.” I want to be clear on this — that is almost never the case. People are better than that, and optometrists are wonderful people. Has an optometrist ever willfully withheld the information that LASIK could help a patient? I’m sure. Also, one time a guy came to fix our garage when I was a kid and then left town after my dad gave him the down payment. Some people just aren’t nice. But that doesn’t change the fact that most people are.

Option Two

That leaves us with option two. An optometrist gave the best advice they could, based on the information available to them. This, in my opinion, is probably the case almost every time there is a discrepancy between what an optometrist and refractive surgeon advise about LASIK. Part of why I believe this is that I’ve had several instances where an optometrist has told a patient they are a candidate for LASIK, only for me to tell them they aren’t. And now seems like as good of a time as any to point out the likely obvious, but still necessary, fact that this only works if the refractive surgeon is also honest and meticulous. If you feel like you got less certain information from your refractive surgeon than your optometrist about your LASIK candidacy, you’ve at least figured out one key piece of information. You can know you shouldn’t get LASIK from that guy, anyway, even if you are a candidate.

In a world where the professionals you look to for help are honest and want the best for you — which I believe is most of the world, most of the time — it comes down to specialization. When a patient asks me what type of contacts will work best for them (that actually happens on a regular basis), I say something like, “Gosh. I’d like to help you, but it’s almost like asking the guy behind you in line at the grocery what contacts you should wear. I know an optometrist who knows more about that than I could ever hope to. You should see her.” I’m not an expert on that. I’m an expert on LASIK, so I can offer really specific reasons for whether or not LASIK is a good idea. If your optometrist says you’re not a LASIK candidate, but you wonder if you actually might be, then you should see an expert on LASIK who you feel like you can trust. Your optometrist is giving you the best information they’ve got and they want the best for you, but sometimes the best for you in this specific case just requires a little more information.

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