By Yoongie Min, OD
Providing ongoing care for post-LASIK patients keeps them in your practice and ensures that they receive the services and products they need.
LASIK has become a common procedure improving the lives of many of those who undergo it, but many of those same patients don’t realize that they still need to visit their eye doctor annually. In addition to co-managing pre- and post-operative care for LASIK patients, ODs need to educate these patients about why they still need to visit for a comprehensive exam each year. Education also is needed about which products, such as sunwear, are still beneficial, and why a successful LASIK procedure doesn’t mean a patient won’t need to address presbyopia.
Co-management of LASIK patients is one of the services I provide. Between my two offices, I now have over 400 post-LASIK patients. The age range is broad, spanning between 18 to about 60, but the most common age for this procedure is 35 to 50. The demographics are typical of the overall demographics of my offices. Here is how my practice educates and provides for patients who have had this procedure.
Vision and Eye Health Could Change
I tell patients that although they can now see well, we need to continue examining them on an annual basis. I tell them that we need to monitor their vision for changes since LASIK does not guarantee their vision will not change. For those getting close to presbyopia, I tell them that they may need reading glasses in the near future. I also tell patients that we need to continue monitoring their eye health for such issues as glaucoma, cataracts and macular degeneration.
Some of my post-LASIK patients are very loyal, coming back yearly for their continued eye health checks and some are very concerned about keeping their annual visits current since some laser centers offer free or reduced cost enhancements if patients keep their annual exams ongoing. Other LASIK patients are very non-compliant and literally disappear after their surgeries, either showing up rarely or never again. In this sense, I don’t think LASIK patients are any different from the general patient base.
Monitor and Treat LASIK-Related Dry Eye
Many LASIK patients are people who have had dryness issues that affected their ability to wear contact lenses. We put many patients pre-operatively on Restasis medication, and continue them on Restasis after the surgery if they continue to have symptoms or show clinical signs of dryness. We also use our normal treatment methods for anyone who has dryness including lubricants, Omega 3 supplements and punctal plugs when necessary.
Educate On Added Need for Sunwear and Driving Eyewear
LASIK patients are more prone to glare problems after surgery, especially at night. We often prescribe night driving eyeglasses with anti-reflective coatings even for small residual amounts of prescription. Many of our patients have LASIK with a monovision modality, so their eyes are unbalanced for distance vision and these patients can often benefit from night driving eyeglasses, as well, that balance both eyes to distance.
In addition, we continue to urge all patients to use sunwear as much as possible and will often prescribe sunwear with small residual levels of prescription when appropriate.
Monitor Eye Health Long-Term
As the years go by, we continue to monitor post-LASIK patients for the same medical eyecare problems that can affect anyone such as glaucoma and cataracts. We also monitor the cornea for any signs of a condition called ectasia, which is an abnormal thinning and bulging of the cornea. Since the surgery leaves the cornea thinner, this can happen, although it is uncommon.
Anticipate the Rare Poor LASIK Outcome
I have only had a few patients over the years with LASIK outcomes they were not happy with. In most of these cases, the problems were not medical, but a result of a patient with unrealistic expectations. Interestingly, I have some patients who had the oldest refractive surgery, radial keratotomy (RK). This was the initial refractive surgery that used radial cuts into the cornea to flatten it. Some of my RK patients have had massive shifts in their refraction over the years, ending up extremely hyperopic. In addition, their best corrected visual acuity is often not correctable easily to 20/20 vision.
Generate Post-LASIK Patient Referral
I ask for referrals of the patient’s friends, family and co-workers who may be interested in LASIK surgery. Often, the patient’s happiness and enthusiasm is highest right after the surgery, so this is a good time to ask for referrals. The referred patients will not necessarily be excellent candidates for surgery, but will then continue coming to our office for their eyeglasses and contact lens needs.
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